Inhaled iloprost in eight heart transplant recipients presenting with post-bypass acute right ventricular dysfunction
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 g 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.
Document Type: Research Article
Affiliations: 1: Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece 2: 1st Cardiosurgery Division, Onassis Cardiac Surgery Center, Athens, Greece 3: Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center, Washington DC, USA 4: Department of Anesthesiology, Onassis Cardiac Surgery Center, Athens, Greece
Publication date: 2006-11-01