title: Oral sildenafil ameliorates impaired pulmonary circulation early after bidirectional cavopulmonary shunt.
abstract: We report a case of successful administration of oral sildenafil (ie, a phosphodiesterase-5 inhibitor) in an infant for impaired pulmonary circulation that caused early clinical deterioration after a bicavopulmonary shunt. The transpulmonary pressure gradient (ie, a clinical indicator of pulmonary circulation) was initially normalized by inhaled nitric oxide; however, an increase in transpulmonary pressure gradient and oxygen desaturation occurred after extubation and discontinuation of inhaled nitric oxide on postoperative day 1. Subsequent administration of oral sildenafil in stepwise doses resulted in normalization of transpulmonary pressure gradient and improved oxygen saturation with successful discontinuation of intravenous vasodilators. Our results suggest that oral sildenafil may be a potent adjunctive therapy for impaired postoperative pulmonary circulation after right heart bypass surgery.
authors.affiliation: Department of Cardiovascular Surgery, Kyoto University Hospital, Kyoto University, Graduate School of Medicine, Kyoto, Japan. snemoto@poh.osaka-med.ac.jp
authors.forename: Shintaro
authors.initials: S
authors.lastname: Nemoto
authors.forename: Eitaro
authors.initials: E
authors.lastname: Umehara
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ikeda
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Itonaga
authors.forename: Masashi
authors.initials: M
authors.lastname: Komeda
mesh_terms: D000284:Administration, Oral; D018610:Heart Bypass, Right / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage; D010879:Piperazines / Q000008:administration & dosage*; D011652:Pulmonary Circulation / Q000187:drug effects*; D011687:Purines / Q000008:administration & dosage; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000008:administration & dosage*; D014652:Vascular Diseases / Q000188:drug therapy* / Q000209:etiology; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate