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Submitted: 02 September 2007 Modified: 01 September 2007
HERDIN Record #: PCHRD090107020934

Use of inhaled prostacyclin analog (Iloprost) on pulmonary vascular reactivity in patients with pulmonary arterial hypertension secondary to congenital cardiac defects: A randomized controlled trial .

Jhuliet J. Balderas,
Wilberto L. Lopez,
Virginia Mappala,
Marites R. Flores,
Ma Lourdes S. Casas

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Background ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Knowledge of the pulmonary vasoreactivity to pharmacologic challenge during acute hemodynamic studies in patients with pulmonary artery hypertension secondary to congenital left-to-right shunts will help in the management and prevention of potential life-threatening pulmonary hypertensive crisis and right heart failure. It is therefore the aim of this study to establish the efficacy and safety of inhalational or aerosolized prostacyclin analog (iloprost) in this subgroup of patients.

Methods and Results ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ A prospective, randomized placebo-controlled interventional study was done on 27 pediatric patients ages 1-19 years old with congenital heart disease who underwent cardiac catheterization for hemodynamics studies. Patients were randomly assigned to receive either placebo or aerosolized iloprost 25 ng/k/min for 10 minutes (N=12). Baseline and post-inhalational hemodynamic parameters were determined for both groups. Aerosolized iloprost caused a decline in the mean pulmonary artery pressure by 7.8 + 1.4 mmHg (p<0.001 vs. baseline) and in the diastolic PA pressure by 5.33 + 2.19 mmHg (p<0.001). Patients who received iloprost had a decreased in the pulmonary vascular resistance by 4.21 + 7.84 woods unit (25% from the baseline) and Rp:Rs ratio declined by 0.19 + 0.21 (p=0.01 vs. baseline) There was a significant effect in the mean and diastolic PA pressure (p<0.001) as compared to placebo. With inhalational iloprost, there was no systemic arterial hypotension noted and there was no significant change in the cardiac output (-0.12 + 0.67 L/min; p =0.54 when tested against baseline)

Conclusion ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Inhaled iloprost exerted a selective pulmonary hemodynamic response, reducing the mean and diastolic pulmonary artery pressure 30 minutes after inhalation. Moreover, it decreased the pulmonary vascular resistance without significant systemic vasodilatation. There were no adverse reactions to iloprost observed. (Author)

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Heart Center Journal
Frequency
Quarterly
Publication Date
January-March 2006
Volume
12
Issue
1
Page(s)
7-13

Objectives

General Objective: To determine the efficacy of inhaled prostacyclin analog (Iloprost) on pulmonary vascular resistance(PVR) during cardiac hemodynamics study with acute vasodilator challenge among patients with pulmonary hypertension secondary to congenital left to right shunts.

Specific objectives:

1. To determine the effect of inhaled iloprost on the following hemodynamic parameters: (1) pulmonary arterial pressure, (2) pulmonary vascular resistance (3) cardiac index (4) systemic blood pressure (5) cardiac output (6) pulmonary blood flow Qp (7) systemic blood flow Qs (8) Qp : Qs (90) systemic vascular resistance of patients undergoing hemodynamics studies for pulmonary hypertension secondary to left to right shunt.

2. To determine the adverse effects of the inhaled iloprost on the said group of patients.

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Philippine Council for Health Research and Development Library Abstract Print Format (Request Document)