Postoperative use of oral sildenafil in pediatric patients with congenital heart disease.
We sought to determine the efficacy of postoperative oral sildenafil therapy (OST) in pediatric patients with congenital heart disease (CHD). A retrospective review of 45 postoperative patients with CHD who received OST was performed. Patients were categorized into three groups according to clinical indications: (1) to stabilize pulmonary vascular reactivity after biventricular repair (group 1 [n = 15]), (2) to lower pulmonary vascular resistance after bidirectional cavopulmonary shunt (group 2 [n = 12]), and (3) to improve post-Fontan hemodynamics (group 3 [n = 18]). Thirty-four patients (34 of 45 [75.6%]) had received inhaled nitric oxide (iNO) while on OST. Mean pulmonary arterial pressure (mPAP), mean systemic blood pressure (mSBP), and peripheral oxygen saturation (SpO(2)) were recorded during the first 24 hours after the initiation of OST. In group 1, the baseline mPAP/mSBP ratio (0.60 +/- 0.17) decreased significantly after the second (0.46 +/- 0.14, p = 0.004) and fourth (0.50 +/- 0.18, p = 0.025) doses of OST. In group 2, baseline SpO(2) (71.0 +/- 12.3%) increased after the fourth dose (75.1 +/- 12.3%, p = 0.04) of OST, without significant changes in mPAP. In group 3, baseline mPAP (14.8 +/- 3.3 mmHg) decreased significantly after the first (13.9 +/- 2.8 mmHg, p = 0.025) and second (13.3 +/- 1.9 mmHg, p = 0.016) doses of OST, without changes in SpO(2). In thirty-one (31 of 34 [92%]) subjects, iNO was discontinued within a median of 2 days after the initiation of OST, without rebound phenomena. There were no OST-related complications. Sildenafil citrate can be used safely in postoperative pediatric patients with CHD. Benefits from OST may be manifested differently in various clinical settings.
Uhm
Ju Yeon
JY
Division of Pediatric Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Poongnap-Dong, Songpa-Ku, Seoul 138-736, Korea.
Jhang
Won-Kyoung
WK
Park
Jeong-Jun
JJ
Seo
Dong-Man
DM
Yun
Sung-Cheol
SC
Yun
Tae-Jin
TJ
D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage; D010100:Oxygen / Q000097:blood; D010879:Piperazines / Q000008:administration & dosage* / Q000009:adverse effects; D011183:Postoperative Complications / Q000188:drug therapy*; D011651:Pulmonary Artery / Q000187:drug effects; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D011687:Purines / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D009569:Nitric Oxide; D000068677:Sildenafil Citrate; D010100:Oxygen