Oral Sildenafil to Control Pulmonary Hypertension after Congenital Heart Surgery

Abstract

This study investigates the role of oral sildenafil in decreasing pulmonary pressure after congenital heart surgery. Between September 2002 and September 2004, among a group of postoperative children with large septal defects, moderate to severe pulmonary hypertension [pulmonary artery (PA) to aortic (Ao) pressure ratio of 0.76 +/- 0.17] and systemic desaturation (Ao Sat = 0.89 +/- 0.11), oral sildenafil (0.3 mg x kg(-1), every 3 hours) was administered for a period of 24-48 hours (sildenafil group). These patients were compared to a group of 22 children with similar pathologies who did not receive sildenafil (control group). Postoperative PA pressure (28.61 +/- 7.80 vs 39.40 +/- 10.80 mm Hg) and PA/Ao pressure (0.28 +/- 0.08 vs 0.41 +/- 0.11) were significantly lower in the sildenafil group ( p = 0.001 and 0.001 respectively). Pulmonary hypertensive crisis was detected in 4 patients in the control group, but none in the sildenafil group ( p = 0.02). There was no significant rise in PA pressure following discontinuation of the drug (26.30 +/- 6.66 vs 28.49 +/- 10.93 mm Hg, p = 0.366). No significant complications were noticed regarding sildenafil use. Low doses of oral sildenafil appear to be effective and safe to control postoperative PA pressure in children. Absence of rebound pulmonary hypertension, availability, and low cost of the drug are considered as its major advantages.

Role of Endothelin-1 Receptor Antagonist in Reducing Perioperative Pulmonary Arterial Hypertension after Surgical Correction of Ventricular Septal Defect

“…ECCT was 82.33 ± 4.42 minutes in ambrisentan group and 87.22 ± 5.89 minutes in control group. These peroperative findings are similar to the study of Peiravian et al 16 PA pressure is significantly reduced following ambrisentan treatment which corresponds with the findings of both Peiravian et al 16 and that of Nemoto et al 17 Mechanical ventilation time was significantly (p=0.013) less (5.96 ±.758 hours) in ambrisentam group than in control group (11.14 ±1.32 hours) and this findings corresponds with the study of Peiravian et al 16 and that of Nemoto et al 17 Reduction of ICU stay and time of ventilating support indicates there is less incidence of development of RV failure due to pulmonary arterial hypertensive crisis in patients of Group-A receiving oral ambrisentan . Perivian et al 16 and Nemoto et al 17 performed two studies with oral sildinafil in their studies.…”

Sildenafil for the Treatment of Pulmonary Hypertension in Pediatric Patients

“…Significant improvements in oxygen saturation also were observed in the sildenafil-treated infants compared with baseline and placebo values (P < 0.05). Sildenafil was shown to decrease postoperative systolic PAP significantly compared with the PAP of placebotreated children [62]. An important measure of PHTN severity is the ratio of PAP to aortic pressure, which was significantly lower with sildenafil than with placebo (P = 0.001).…”

“…Eight prospective studies, including a series of 87 children (ages ranging from infancy to 19 years) taking oral sildenafil, describe sildenafil's efficacy for improving hemodynamics and exercise tolerance [6,36,45,58,59,62,63,69]. Three of the prospective studies were randomized controlled trials involving pediatric patients with either persistent PHTN of the newborn or PHTN related to congenital heart disease [6,58,62]. Sildenafil improved the oxygenation index (calculated as fraction of inspired oxygen × mean airway pressure/arterial partial pressure of oxygen) compared with baseline and placebo values for seven infants within 6-30 h after initiation of treatment [6].…”

“…An important measure of PHTN severity is the ratio of PAP to aortic pressure, which was significantly lower with sildenafil than with placebo (P = 0.001). Effective doses of sildenafil in these prospective studies ranged from 0.3 to 8 mg/kg/day [6,58,62].…”

“…Table 3 summarizes the adverse events noted in pediatric studies and case reports. GI upset [62] Not otherwise described 2 <1…”