Inhaled iloprost in eight heart transplant recipients presenting with post-bypass acute right ventricular dysfunction.
BACKGROUND
During heart transplantation, weaning from cardiopulmonary bypass may be particularly laborious as a result of superimposed acute right ventricular dysfunction in the setting of pre-existing pulmonary hypertension. Research in recent years has focused on inhaled vasodilatory treatment modalities which selectively target the pulmonary circulation.


METHODS
We present a series of eight patients in whom inhaled iloprost, a synthetic prostacyclin analog, was used to treat pulmonary hypertension and right ventricular dysfunction detected by transesophageal echocardiography during a heart transplant procedure. In addition to conventional inotropic support, 20 mug of inhaled iloprost was administered via nebulized aerosol for a 20-min period. Complete sets of hemodynamic measurements were obtained before inhalation and during and after cessation of the inhalation period.


RESULTS
Inhaled iloprost decreased the transpulmonary gradient at the end of the inhalation period relative to baseline (8.2 +/- 1.6 mmHg vs. 11.2 +/- 0.9 mmHg, P < 0.05). The mean pulmonary artery pressure to systemic artery pressure ratio decreased over this period (0.24 +/- 0.07 vs. 0.44 +/- 0.09, P < 0.05). A statistically significant decrease in the pulmonary vascular resistance to systemic vascular resistance ratio was also observed (0.10 +/- 0.02 vs. 0.19 +/- 0.02, P < 0.05). Improved indices of right ventricular function were observed in echocardiographic monitoring.


CONCLUSIONS
During heart transplantation procedures, episodes of pulmonary hypertension can be successfully treated with inhaled iloprost administration, without untoward side-effects or significant systemic impact.
Theodoraki
K
K
Department of Anesthesiology, Areteion University Hospital, Athens, Greece. ktheodoraki@hotmail.com
Tsiapras
D
D
Tsourelis
L
L
Zarkalis
D
D
Sfirakis
P
P
Kapetanakis
E
E
Alivizatos
P
P
Antoniou
T
T
D000280:Administration, Inhalation; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D002311:Cardiomyopathy, Dilated / Q000601:surgery; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D016285:Iloprost / Q000008:administration & dosage* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000188:drug therapy*
D014665:Vasodilator Agents; D016285:Iloprost