Inhaled Prostacyclin, Nitric Oxide, and Nitroprusside in Pulmonary Hypertension After Mitral Valve Replacement

Fattouch, Khalil; Sbraga, Fabrizio; Bianco, Giuseppe; Saglio, Giuseppe; Gucciardo, Marco; Sampognaro, Roberto; Ruvolo, Giovanni

doi:10.1111/j.0886-0440.2005.200383w.x

Cited by 118 publications

(104 citation statements)

References 24 publications

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“…229 A head-to-head comparison of inhaled prostacyclin and NO in this population found both to be effective and to have better tolerability than intravenous nitroprusside. 230 Inhaled iloprost has been used successfully in patients with PH and acute RV failure during and following cardiac transplantation. 231 Sildenafil has been reported to have beneficial hemodynamic effects when administered by nasogastric tube in patients undergoing cardiac surgery who develop intraoperative PH.…”

Section: Postoperative Pulmonary Hypertensionmentioning

confidence: 99%

ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension

McLaughlin¹,

Archer²,

Badesch³

et al. 2009

Circulation

1,077

605

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Section: Postoperative Pulmonary Hypertensionmentioning

confidence: 99%

ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension

McLaughlin¹,

Archer²,

Badesch³

et al. 2009

Circulation

1,077

605

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“…The etiology of PH is not completely understood, but idiopathic and familial factors have been implicated. PH often occurs in children with congenital heart disease and after cardiac surgery (Hopkins et al, 1991), and it affects adults, in particular, with HIV infection, chronic obstructive pulmonary disease, and other cardiopulmonary disease (Fattouch et al, 2005). The course of PH progresses rapidly and ultimately leads to right ventricular failure and premature death (D'Alonzo et al, 1991).…”

mentioning

confidence: 99%

Impaired Vasoconstriction and Nitric Oxide-Mediated Relaxation in Pulmonary Arteries of Hypoxia- and Monocrotaline-Induced Pulmonary Hypertensive Rats

Mam

Tanbe²,

Vitali³

et al. 2009

J Pharmacol Exp Ther

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Pulmonary hypertension (PH) is a life-threatening disease with unclear vascular mechanisms. We tested whether PH involves abnormal pulmonary vasoconstriction and impaired vasodilation. Male Sprague-Dawley rats were exposed to hypoxia (9% O 2 ) for 2 weeks or injected with single dose of monocrotaline (MCT, 60 mg/kg s.c.). Control rats were normoxic or injected with saline. After the hemodynamic measurements were performed, pulmonary and mesenteric arteries were isolated for measurement of vascular function. Hematocrit was elevated in hypoxic rats. Right ventricular systolic pressure and Fulton's Index [right/(left ϩ septum) ventricular weight] were greater in hypoxic and MCT-treated rats than in normoxic rats. Pulmonary artery contraction by phenylephrine and 96 mM KCl was less in hypoxic and MCT-treated rats than in normoxic rats. Acetylcholine-induced relaxation was less in the pulmonary arteries of hypoxic and MCT-treated rats than of normoxic rats, suggesting reduced effects of endothelium-derived vasodilators. The nitric oxide synthase inhibitor, N -nitro-L-arginine methyl ester, and the guanylate cyclase inhibitor, 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one, inhibited acetylcholine relaxation, suggesting that it was mediated by nitric oxide (NO)-cGMP. The NO donor sodium nitroprusside caused less relaxation in the pulmonary arteries of hypoxic and MCT-treated than of normoxic rats, suggesting decreased responsiveness of vascular smooth muscle cells (VSMCs) to vasodilators. Phenylephrine and KCl contraction and acetylcholine and sodium nitroprusside relaxation were not different in the mesenteric arteries from all groups. In lung tissue sections, the wall thickness of pulmonary arterioles was greater in hypoxic and MCT-treated rats than in normoxic rats. The specific reductions in pulmonary, but not systemic, arterial vasoconstriction and vasodilation in hypoxiaand MCT-induced PH are consistent with the possibility of de-differentiation of pulmonary VSMCs to a more proliferative/ synthetic and less contractile phenotype in PH.

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“…Inhaled prostacyclin has advantages over iNO, as it is free from toxic side effects and is easier to administer [19]. However, because of its short half-life and instability, prostacyclin has to be inhaled continuously.…”

Section: Advantage Of Inhaled Vasodilatorsmentioning

confidence: 99%

Management of Adult Patients with Perioperative Pulmonary Hypertension: Technical Aspects and Therapeutic Options

2010

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Pulmonary hypertension (PH) is an independent risk factor for increased mortality in patients undergoing heart surgery. Existing chronic PH may be exacerbated by acute post-bypass PH, and this can lead to acute right ventricular failure. The prevention and treatment of right ventricular failure in cardiac surgery is based on three principles: optimize right ventricular preload, improve right ventricular contractility, minimize right ventricular afterload. The last of these may involve specific measures such as the inhalation of nitric oxide (NO) or of the stable prostacyclin analogue iloprost. The advantage of these inhalable substances is their pulmonary selectivity, and the subsequent reduction in systemic side effects. In order to avoid disastrous results in high-risk cardiac surgical patients, intra- and post-operative monitoring with pressure lines, a qualified team that pays attention to details, and an aggressive and early treatment in the operating room with inhaled iloprost and/or NO is necessary. The philosophy of ‘wait and see’ should be abandoned in favour of ‘be suspicious and act early’. In a prospective randomized trial, the efficacies of inhaled iloprost and of inhaled NO in the therapy of PH immediately following weaning from cardiopulmonary bypass in cardiac surgical patients were compared. Iloprost proved to be significantly more effective with respect to mean pulmonary arterial pressure, pulmonary vascular resistance, and cardiac output than inhaled NO.

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Inhaled Prostacyclin, Nitric Oxide, and Nitroprusside in Pulmonary Hypertension After Mitral Valve Replacement

Cited by 118 publications

References 24 publications

ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension

ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension

Impaired Vasoconstriction and Nitric Oxide-Mediated Relaxation in Pulmonary Arteries of Hypoxia- and Monocrotaline-Induced Pulmonary Hypertensive Rats

Management of Adult Patients with Perioperative Pulmonary Hypertension: Technical Aspects and Therapeutic Options

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