Aerosolized iloprost for postoperative pulmonary hypertensive crisis in children with congenital heart disease
Section snippets
Materials and methods
This study was approved by the Institutional Review Board and written informed consent was obtained from the patient's parents prior to enrollment.
In this prospective open-label single arm study, patients at risk of developing PHC [3] were monitored with a transthoracic pulmonary artery catheter in order to measure the pulmonary pressure during PHC after surgery for congenital cardiac defects. Patients were eligible, if they had cardiac surgery under cardiopulmonary bypass for congenital heart
Statistical analysis
Data are expressed as mean ± standard error of the mean. The Wilcoxon Signed Rank's Test was used to compare the hemodynamic differences between pre- and post-iloprost treatment during PHC.
Hemodynamic data
The administration of inhaled iloprost significantly reduced the mean PAP from 47.9 ± 14.9 to 30.2 ± 7.9 mmHg (p = 0.012) and improved the oxygen saturation from 82.2 ± 16.7 to 93.4 ± 11.5% (p = 0.012) while being ventilated with 100% oxygen as shown in Fig. 1, Fig. 2. The mean systemic blood pressure tended to increase from 59.4 ± 12.1 to 64 ± 10.3 mmHg (p = 0.16) as shown in Fig. 3. There were no significant changes in the other hemodynamic measurements. All eight children continued to improve with iloprost
Discussion
Congenital heart defects causing increased pulmonary blood flow or pulmonary venous congestion frequently lead to pulmonary hypertension. The chronically increased blood flow and increased blood pressure in the pulmonary vascular system results in arterial smooth muscle cell hypertrophy and hyperplasia. This subsequently leads to pulmonary vasoconstriction followed by cellular remodeling involving endothelial cells and smooth muscle cells, which is eventually also impairing the
Conclusion
In this study iloprost was effective as a selective pulmonary vasodilator in treatment of the PHC in selected children undergoing congenital heart surgery.
Acknowledgement
We thank Axel Boehnke, M.D. for his editorial work with this manuscript.
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2016, Cardiology ClinicsCitation Excerpt :Iloprost requires patient cooperation with the treatment administration lasting 10 to 15 minutes,122 which is difficult for young children.123 In the acute setting, inhaled iloprost lowers mean pulmonary artery pressure and improves systemic oxygen saturation.124 Some children may develop reactive airways obstruction limiting usefulness of this therapy.