Role of Oral Sildenafil in the Treatment of Right Ventricular Dysfunction After Heart Transplantation

The Use of Oral Sildenafil for Management of Right Ventricular Dysfunction After Pediatric Heart Transplantation

“…A study in 10 postoperative adult heart transplant patients with right ventricular dysfunction from an elevated PVRI (mean ¼ 3.9 WU) demonstrated a significant drop in SPAP on sildenafil after intravenous and inhalational agents were weaned off. This study also noted that an earlier start to sildenafil postoperatively allowed for a quicker wean from intravenous and inhalational vasodilators after transplantation (22 days vs. 16 days) (9). Another study of 13 postoperative adult heart transplant patients with right ventricular dysfunction and high PVRI (mean ¼ 10.4 WU) showed a significant improvement in right ventricular function, PVRI and TPG after sildenafil initiation (10).…”

“…Postoperatively, the donor right ventricle responds poorly when subjected to the acute afterload-dependent hemodynamic changes associated with high PVRI in the transplant recipient. Progressive right ventricular dilatation, tricuspid regurgitation and decreased systolic function of the right ventricle lead to decreased left ventricular preload and low cardiac output syndrome (9).…”

“…It is a pulmonary vasodilator that has been shown to be effective in pediatric patients with persistent pulmonary hypertension of the newborn (3,4), idiopathic pulmonary hypertension (5,6) and pulmonary hypertension from congenital heart disease (7,8). While it has been shown to be effective in treating right ventricular dysfunction after heart transplantation in adults (9,10), its efficacy and safety have not been well evaluated in the pediatric population after heart transplantation. Our primary study hypothesis was that the use of sildenafil in pediatric patients after orthotopic heart transplantation leads to improvement of right ventricular dysfunction and PVRI.…”

Impact of pulmonary hypertension on early hemodynamics, morbidity and mortality after orthotopic heart transplantation. A single center study

“…In order to prevent this, a number of medications and/or techniques (prostaglandin E1, prostacyclin, inhaled nitric oxide and ventricular assistance devices) have been proposed and are used to decrease pulmonary pressures. Most of these treatment strategies have been aimed at the management of patients with primary pulmonary hypertension but they have turned out to be very useful in the preoperative conditioning of patients with secondary pulmonary hypertension stemming from chronic heart failure [11][12][13] . New approaches based on treatment of heart transplant candidates with pulmonary hypertension have increased the number of patients suitable for placement on the waiting list and additionally it has shown beneficial effect on survival after HTx.…”

Intensive therapy after solid organ transplantation

“…"Mammalian-target-of-rapamycin"-Inhibitoren (mTOR-Inhibitoren: Sirolimus, Everolimus) blockieren spezifisch die T-Zell-Proliferation durch Unterbrechung der intrazellulären Signalweiterleitung nach Aktivierung des IL-2- Abb. 2 8 Wirkmechanismus der Immunsuppressiva an der T-Helferzelle. AP-1 "activator protein-1"; CD "cluster of differentiation"; FKBP FK506-bindendes Protein; IL Interleukin; M, G1 und G2 Phasen des Zellzyklus; mTOR "mammalian target of rapamycin"; NFAT "nuclear factor of activated T lymphocytes"; NFκB "nuclear factor ‚kappa-light-chain-enhancer' of activated B-cells"; TCR "T cell receptor"…”