Reversibility of medically unresponsive pulmonary hypertension with nesiritide in a cardiac transplant recipient.
Pulmonary hypertension unresponsive to medical therapy is considered by most centers to be a contraindication for orthotopic cardiac transplantation. This article describes a patient with unresponsive severe pulmonary hypertension who, despite a combination of maximal doses of dobutamine, milrinone, and nitroprusside infusion, responded to nesiritide (Natrecor) infusion with improvement in pulmonary hemodynamics. The patient was considered a high risk for transplantation because of significant pulmonary hypertension in spite of maximum oral therapy and continuous intravenous milrinone. Severe irreversible pulmonary hypertension persisted with a combination of dobutamine, milrinone, and nitroprusside, with pulmonary artery pressure (PA) of 88/44 mm Hg, a transpulmonary gradient (TPG) of 27, and pulmonary vascular resistance (PVR) of 5.79 Wood units. Upon addition of nesiritide, within 24 hours, there was a sustained decrease in PA to 47/30, TPG of 15, and PVR of 3.75 Wood units. The patient underwent successful left ventricular assist device placement soon after nesiritide infusion demonstrated reversibility of pulmonary hypertension. He subsequently underwent uneventful orthotopic cardiac transplantation and has done well with normal right heart pressures. This case illustrates that addition of nesiritide to standard therapy can reverse significant unresponsive pulmonary hypertension and make a patient eligible for left ventricular assist device and orthotopic cardiac transplantation.
Bhat
Geetha
G
Division of Cardiology, University of Louisville, 550 South Jackson Street, 3rd Floor, ACB Bldg., Louisville, KY 40202 40202, USA.
Costea
Alex
A
D002302:Cardiac Output / Q000187:drug effects; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use*
D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain