Successful treatment of a patient with severe pulmonary hypertension due to perivalvular leakage at aortic and mitral positions after aortic and mitral valve replacement.
A 33-year-old-man had severe secondary pulmonary hypertension due to perivalvular leakage at the aortic and mitral positions after aortic and mitral valve replacement. Preoperative cardiac catheterization revealed pulmonary artery pressure of 105/45 mmHg and pulmonary vascular resistance of 929 dynes.s.cm(-5) To save the patient, we performed aortic and mitral valve re-replacement, and tricuspid annuloplasty. After surgery, selective pulmonary vasodilators, beraprost sodium, inhaled nitric oxide, and intravenous prostaglandin (PG) I(2) were administered because of persistent severe pulmonary hypertension. Cardiac catheterization on postoperative day 58 showed that the pulmonary artery pressure and pulmonary vascular resistance had decreased to 40/20 mmHg and 87.7 dynes x s x cm(-5), respectively The simultaneous use of inhaled nitric oxide, intravenous PGI(2), and oral beraprost sodium might be useful for treating postoperative persistent pulmonary hypertension.
Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan. takashiren@yahoo.co.jp
Takashi
T
Miura
Hiroshi
H
Nishida
Akihiko
A
Kawai
Tomohiro
T
Maeda
Hiromi
H
Kurosawa
Hitoshi
H
Koyanagi
D000280:Administration, Inhalation; D000284:Administration, Oral; D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001794:Blood Pressure / Q000187:drug effects; D006328:Cardiac Catheterization; D003131:Combined Modality Therapy; D020878:Device Removal; D004359:Drug Therapy, Combination; D011464:Epoprostenol / Q000008:administration & dosage / Q000031:analogs & derivatives; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007262:Infusions, Intravenous; D008297:Male; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D009569:Nitric Oxide / Q000008:administration & dosage; D011652:Pulmonary Circulation / Q000187:drug effects; D012086:Reoperation; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage*
D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D009569:Nitric Oxide; C048081:beraprost; D011464:Epoprostenol