title: Acute pulmonary vasoreactivity test with sildenafil or nitric monoxide before left ventricular assist device implantation.
abstract: There has been no established medical therapy to ameliorate pulmonary hypertension (PH) owing to left heart disease (LHD-PH). It has recently been shown that the left ventricular assist device (LVAD) can improve LHD-PH and therefore has the potential to become a major bridge tool for heart transplantation (HTx). However, some patients still have persistent PH even after LVAD treatment. It is essential to demonstrate the reversibility of end-organ dysfunction, including PH, prior to implantable LVAD treatment, especially in Japan, because implantable LVAD treatment is indicated only as bridge to transplantation. Here we report a patient with LHD-PH whose PH was demonstrated to be reversible by the acute pulmonary vasoreactivity test (APVT) with nitrogen monoxide (NO) and the phosphodiesterase-5 inhibitor sildenafil. Both inhaled NO and sildenafil reduced pulmonary vascular resistance, but pulmonary capillary wedge pressure was increased by NO, which was conversely decreased under increased cardiac output by sildenafil. After the patient was listed as an HTx recipient, pulmonary vascular resistance recovered down to an acceptable range with LVAD treatment. Based on these findings, we suggest that the APVT with sildenafil may be a useful and safe tool to predict improvement of PH after LVAD treatment.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan, imamurate-int@h.u-tokyo.ac.jp.
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Imamura
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Hatano
authors.forename: Naoko
authors.initials: N
authors.lastname: Kato
authors.forename: Shun
authors.initials: S
authors.lastname: Minatsuki
authors.forename: Hironori
authors.initials: H
authors.lastname: Muraoka
authors.forename: Toshiro
authors.initials: T
authors.lastname: Inaba
authors.forename: Hisataka
authors.initials: H
authors.lastname: Maki
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Kimura
authors.forename: Osamu
authors.initials: O
authors.lastname: Kinoshita
authors.forename: Taro
authors.initials: T
authors.lastname: Shiga
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yao
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000601:surgery*; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D009569:Nitric Oxide; D010879:Piperazines; D019919:Prosthesis Implantation; D011687:Purines; D000068677:Sildenafil Citrate; D013450:Sulfones
chemical_list: D010879:Piperazines; D011687:Purines; D013450:Sulfones; D009569:Nitric Oxide; D000068677:Sildenafil Citrate
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