Aerosolized Iloprost Therapy Could Not Replace Long-term IV Epoprostenol (Prostacyclin) Administration in Severe Pulmonary Hypertension

Objectives: To switch patients with severe pulmonaryhypertension and previous life-threatening catheter-relatedcomplications from long-term IV epoprostenol therapy to aerosolizediloprost therapy. Design: Open, uncontrolledtrial. Setting: Medical ICU of a universityhospital. Patients: Two patients with primarypulmonary hypertension and one patient with pulmonary hypertensionafter surgical closure of atrial septal defect (mean pulmonary arterypressure ≥ 50 mm Hg). All were classified as New York Heart Association class II under treatment with continuous IV epoprostenolfor 4 years. Interventions: Stepwise reduction of IVepoprostenol (1 ng/kg/min steps every 3 to 10 h) during repeatedinhalations of aerosolized iloprost (150 to 300 μg/d with 6 to 18inhalations/d). Continuous pulmonary and systemic arterial monitoringwere performed. Results: Aerosolized iloprost reducedpulmonary artery pressure by 49%, 49%, and 45%, respectively, andincreased cardiac output by 70%, 75%, and 41% in the three patients. The effect lasted for 20 min and was similar at different doses of IVepoprostenol. Persistent treatment change to inhaled iloprost could notbe achieved because all patients developed signs of right heartfailure. After termination of iloprost inhalations, return to standardepoprostenol therapy led to clinical and hemodynamic restoration. Conclusions: Although aerosolized iloprost demonstratedshort-term hemodynamic effects, it could not be utilized as alternativechronic vasodilator in patients with severe pulmonaryhypertension.