title: Effect of preoperative oral sildenafil on severe pulmonary artery hypertension in patients undergoing mitral valve replacement.
abstract: OBJECTIVE
  Long standing mitral valve disease is usually associated with severe pulmonary hypertension. Perioperative pulmonary hypertension is a risk factor for right ventricular (RV) failure and a cause for morbidity and mortality in patients undergoing mitral valve replacement. Phosphodiesterase 5 inhibitor-sildenafil citrate is widely used to treat primary pulmonary hypertension. There is a lack of evidence of effects of oral sildenafil on secondary pulmonary hypertension due to mitral valve disease. The study aims to assess the effectiveness of preoperative oral sildenafil on severe pulmonary hypertension and incidence of RV failure in patients undergoing mitral valve replacement surgery.
  
  
  METHODS
  A total of 40 patients scheduled for mitral valve replacement with severe pulmonary hypertension (RV systolic pressure (RVSP) ≥60 mmHg) on preoperative transthoracic echo were randomly treated with oral sildenafil 25 mg (N = 20) or placebo (N = 20) eight hourly for 24 h before surgery. Hemodynamic variables were measured 20 min after insertion of pulmonary artery catheter (PAC) under anesthesia (T1), 20 min at weaning from cardiopulmonary bypass (CPB) (T2) and after 1,2, and 6 h (T3, T4, T5, respectively) during the postoperative period.
  
  
  RESULTS
  Systolic and mean pulmonary artery pressure (MPAP) and pulmonary vascular resistance index (PVRI) were significantly lower (P < 0.0001) in sildenafil group at all times. Ventilation time and postoperative recovery room stay were significantly lower (P < 0.001) in sildenafil group.
  
  
  CONCLUSIONS
  Sildenafil produces significant pulmonary vasodilatory effect as compared with placebo in mitral valve replacement patients with severe pulmonary hypertension. It also reduces ventilation time and intensive care unit (ICU) stay time as compared with placebo. It is concluded that sildenafil is effective in reducing pulmonary hypertension when administered preoperatively in patients with severe pulmonary hypertension undergoing mitral valve replacement surgery.
authors.affiliation: Department of Cardiac Anesthesia, Uttambhai Nathalal Mehta Institute of Cardiology and Research Center, Sir Byramjee Jeejeebhoy Medical College, Civil Hospital, Asarwa, Ahmadabad, Gujarat, India.
authors.forename: Hemang
authors.initials: H
authors.lastname: Gandhi
authors.affiliation: Department of Cardiac Anesthesia, Uttambhai Nathalal Mehta Institute of Cardiology and Research Center, Sir Byramjee Jeejeebhoy Medical College, Civil Hospital, Asarwa, Ahmadabad, Gujarat, India.
authors.forename: Bipin
authors.initials: B
authors.lastname: Shah
authors.affiliation: Department of Cardiac Anesthesia, Uttambhai Nathalal Mehta Institute of Cardiology and Research Center, Sir Byramjee Jeejeebhoy Medical College, Civil Hospital, Asarwa, Ahmadabad, Gujarat, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Patel
authors.affiliation: Department of Cardiac Anesthesia, Uttambhai Nathalal Mehta Institute of Cardiology and Research Center, Sir Byramjee Jeejeebhoy Medical College, Civil Hospital, Asarwa, Ahmadabad, Gujarat, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Toshani
authors.affiliation: Department of Cardiac Anesthesia, Uttambhai Nathalal Mehta Institute of Cardiology and Research Center, Sir Byramjee Jeejeebhoy Medical College, Civil Hospital, Asarwa, Ahmadabad, Gujarat, India.
authors.forename: Jigisha
authors.initials: J
authors.lastname: Pujara
authors.affiliation: Department of Cardio Vascular Thoracic Surgery, Uttambhai Nathalal Mehta Institute of Cardiology and Research Center, Sir Byramjee Jeejeebhoy Medical College, Civil Hospital, Asarwa, Ahmadabad, Gujarat, India.
authors.forename: Jignesh
authors.initials: J
authors.lastname: Kothari
authors.affiliation: Department of Cardio Vascular Thoracic Surgery, Uttambhai Nathalal Mehta Institute of Cardiology and Research Center, Sir Byramjee Jeejeebhoy Medical College, Civil Hospital, Asarwa, Ahmadabad, Gujarat, India.
authors.forename: Naman
authors.initials: N
authors.lastname: Shastri
mesh_terms: D000284:Administration, Oral; D000328:Adult; D062186:Arterial Pressure / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000637:transplantation*; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use*; D057234:Preoperative Period; D011687:Purines / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use*
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate
keywords: Mitral valve disease; oral sildenafil; phosphodiesterase 5; phosphodiesterase 5 inhibitor; pulmonary hypertension; right ventricular failureEctua vigna Sim terurs