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Hemodynamic effects of combination therapy with inhaled nitric oxide and iloprost in patients with pulmonary hypertension and right ventricular dysfunction after high-risk cardiac surgery.
Hemodynamic effects of combination therapy with inhaled nitric oxide and iloprost in patients with pulmonary hypertension and right ventricular dysfunction after high-risk cardiac surgery.
- Source :
-
Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2013 Jun; Vol. 27 (3), pp. 459-66. Date of Electronic Publication: 2012 Oct 10. - Publication Year :
- 2013
-
Abstract
- Objective: The purpose of this study was to evaluate the hemodynamic effects of inhaled nitric oxide (NO) plus aerosolized iloprost in patients with pulmonary hypertension/right ventricular dysfunction after cardiac surgery.<br />Design: A retrospective study.<br />Setting: A single center.<br />Participants: Eight consecutive patients with valve disease and postextracorporeal circulation (ECC) pulmonary hypertension/right ventricular dysfunction.<br />Intervention: The continuous inhalation of nitric oxide (10 ppm) and iloprost, 10 μg, in repeated doses.<br />Measurements and Main Results: The hemodynamic profile was obtained before inhalation, during the administration of inhaled NO alone (prior and after iloprost), and after the first 2 doses of iloprost. Tricuspid annular velocity and tricuspid annular plane systolic excursion were estimated at baseline and before and after adding iloprost. At the end of the protocol, there were significant decreases in pulmonary vascular resistance (p < 0.001), the mean pulmonary arterial pressure (p < 0.001), and the mean pulmonary artery pressure/mean arterial pressure ratio (p = 0.006). Both tricuspid annular velocity (p < 0.001) and tricuspid annular plane systolic excursion (p < 0.001) increased. The cardiac index (p < 0.001) and venous blood oxygen saturation (p = 0.001) increased throughout the evaluation period. Each iloprost dose was associated with further decreases in pulmonary vascular resistances/pressure. By comparing data at the beginning of inhaled NO with those after the second dose of iloprost, the authors noticed decreases in pulmonary vascular resistances (p = 0.004) and the mean pulmonary artery pressure (p = 0.017) and rises in tricuspid annular velocity (p < 0.001) and tricuspid annular systolic plane systolic excursion (p < 0.001).<br />Conclusions: Inhaled NO and iloprost significantly reduced pulmonary hypertension and contributed to the improvement in right ventricular function. Inhaled NO and iloprost have additive effects on pulmonary vasculature.<br /> (Copyright © 2013 Elsevier Inc. All rights reserved.)
- Subjects :
- Aerosols
Aged
Arterial Pressure physiology
Electrocardiography
Extracorporeal Circulation
Female
Heart Valves surgery
Humans
Iloprost administration & dosage
Male
Middle Aged
Nitric Oxide administration & dosage
Risk
Treatment Outcome
Vascular Resistance physiology
Vasodilator Agents administration & dosage
Cardiac Surgical Procedures methods
Hemodynamics drug effects
Hypertension, Pulmonary drug therapy
Hypertension, Pulmonary physiopathology
Iloprost therapeutic use
Nitric Oxide therapeutic use
Vasodilator Agents therapeutic use
Ventricular Dysfunction, Right drug therapy
Ventricular Dysfunction, Right physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8422
- Volume :
- 27
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of cardiothoracic and vascular anesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 23063102
- Full Text :
- https://doi.org/10.1053/j.jvca.2012.07.020