title: Postoperative use of oral sildenafil in pediatric patients with congenital heart disease.
abstract: 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.
authors.affiliation: Division of Pediatric Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Poongnap-Dong, Songpa-Ku, Seoul 138-736, Korea.
authors.forename: Ju Yeon
authors.initials: JY
authors.lastname: Uhm
authors.forename: Won-Kyoung
authors.initials: WK
authors.lastname: Jhang
authors.forename: Jeong-Jun
authors.initials: JJ
authors.lastname: Park
authors.forename: Dong-Man
authors.initials: DM
authors.lastname: Seo
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Yun
mesh_terms: 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
chemical_list: D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D009569:Nitric Oxide; D000068677:Sildenafil Citrate; D010100:Oxygen