Role of sildenafil in acute posttransplant right ventricular dysfunction: successful experience in 13 consecutive patients.
BACKGROUND
Superimposed acute right ventricular dysfunction in the setting of preexisting pulmonary hypertension is a nearly fatal complication after heart transplantation. The optimal treatment modality remains a matter of debate. Recently, sildenafil citrate, a nonselective pulmonary vasodilator, has gained popularity in the treatment of pulmonary hypertension in transplant candidates.


METHODS
Herein we have presented a series of 13 patients in whom sildenafil was used to treat right ventricular dysfunction and pulmonary hypertension as detected by transesophageal echocardiography and Swan-Ganz right heart catheterization after heart transplant. Their characteristics were mean age 49+/-11.4 years; 38.4% with previous cardiac procedures, 30.8% status I, basal pulmonary vascular resistance index 10.4+/-4.6 WoodU, mean transpulmonary gradient 18.7+/-5.4 mmHg. In addition to conventional inodilator support, we administered 1 to 3 mg per kilogram of sildenafil. Complete hemodynamic measurements were obtained before and after the institution of the therapy and at 1-month follow-up.


RESULTS
Within the first 72 hours, acute right ventricular dysfunction resolved in all cases without untoward side effects or significant systemic impact. Sildenafil significantly decreased the transpulmonary gradient and pulmonary vascular resistance index relative to baseline values; 5.6+/-1.82 versus 10.4+/-4.6 WU, (P< .05), 13.5+/-3.4 mm Hg versus 18.7+/-5.4 mm Hg (P< .05), respectively. Improved indices of right ventricular function were observed on echocardiographic monitoring. After 1 month, sildenafil treatment was discontinued.


CONCLUSIONS
Management of acute right ventricular dysfunction in heart transplant recipients with pulmonary hypertension using sildenafil proved safe and effective.
De Santo
L S
LS
University of Foggia, Medical School, Foggia, Italy. l.desanto@unifg.it
Mastroianni
C
C
Romano
G
G
Amarelli
C
C
Marra
C
C
Maiello
C
C
Galdieri
N
N
Della Corte
A
A
Cotrufo
M
M
Caianiello
G
G
D000328:Adult; D006328:Cardiac Catheterization; D002648:Child; D017548:Echocardiography, Transesophageal; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D006353:Heart-Assist Devices; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy; D011687:Purines / Q000627:therapeutic use; D011859:Radiography; D012189:Retrospective Studies; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use*; D016896:Treatment Outcome; D014655:Vascular Resistance; D014665:Vasodilator Agents / Q000627:therapeutic use*; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy* / Q000209:etiology
D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate