Inhaled Iloprost in Eight Heart Transplant Recipients Presenting with Post-bypass Acute Right Ventricular Dysfunction.
From: Department of Anesthesiology, Areteion University Hospital, Athens, Greece. ktheodoraki@hotmail.com
Acta anaesthesiologica Scandinavica
- Publish Date: Nov 2006
- ISSN: 0001-5172
- Volume: 50
- Issue: 10
- Pages: 1213-7
- Medium: Print
- Language: English
- Citation (JAMA): Theodoraki K, Tsiapras D, Tsourelis L, et al. Inhaled Iloprost in Eight Heart Transplant Recipients Presenting with Post-bypass Acute Right Ventricular Dysfunction.. Nov 2006;50:1213-7
Abstract
BACKGROUND: During heart transplantation, weaning from cardiopulmonary bypass may be particularly laborious as a result of superimposed acute right ventricular dysfunction in the setting of pre-existing pulmonary hypertension. Research in recent years has focused on inhaled vasodilatory treatment modalities which selectively target the pulmonary circulation. METHODS: We present a series of eight patients in whom inhaled iloprost, a synthetic prostacyclin analog, was used to treat pulmonary hypertension and right ventricular dysfunction detected by transesophageal echocardiography during a heart transplant procedure. In addition to conventional inotropic support, 20 mug of inhaled iloprost was administered via nebulized aerosol for a 20-min period. Complete sets of hemodynamic measurements were obtained before inhalation and during and after cessation of the inhalation period. RESULTS: Inhaled iloprost decreased the transpulmonary gradient at the end of the inhalation period relative to baseline (8.2 +/- 1.6 mmHg vs. 11.2 +/- 0.9 mmHg, P < 0.05). The mean pulmonary artery pressure to systemic artery pressure ratio decreased over this period (0.24 +/- 0.07 vs. 0.44 +/- 0.09, P < 0.05). A statistically significant decrease in the pulmonary vascular resistance to systemic vascular resistance ratio was also observed (0.10 +/- 0.02 vs. 0.19 +/- 0.02, P < 0.05). Improved indices of right ventricular function were observed in echocardiographic monitoring. CONCLUSION: During heart transplantation procedures, episodes of pulmonary hypertension can be successfully treated with inhaled iloprost administration, without untoward side-effects or significant systemic impact.
Mesh Headings (Keywords): Administration, Inhalation, Adult, Blood Pressure, Cardiomyopathy, Dilated, Female, Heart Rate, Heart Transplantation, Humans, Iloprost, Male, Middle Aged, Myocardial Ischemia, Vascular Resistance, Vasodilator Agents, Ventricular Dysfunction, Right
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