Aerolized prostacyclin for preoperative evaluation and postoperative treatment of patients with pulmonary hypertension

Background: Inhaled nitric oxide (NO) has been shown to selectively lower pulmonary vascular resistance and is applied in patients with pulmonary hypertension (PHT). However, application and monitoring is complex and not always successful (''non-responders''). We evaluated the effect of aerolized prostacyclin (aePGI(2)) as a therapeutic alternate to NO. Patients and methods: aePGI(2) and NO were applied to patients with different causes of pulmonary hypertension (Group 1a: preoperative patients with intracardiac shunting defects and Eisenmenger's disease, n = 30; Group 1b: patients with primary or postoperative PHT, n = 13; Group 2: PHT immediately following surgery for congenital heart disease, n = 6). Results: Pulmonary vascular resistance could be lowered significantly (Group 1a: from 91% of systemic vascular resistance to 58% with NO and 53% with aePGI(2); Group 1b: from 20.2 Wood Units * m(2) to 13.4 and 11.3; Group 2: from 24.9 Wood Units * m(2) to 9.5 and 10.5); cardiac index increased (Group 1b: from 2.96 to 3.55 and 3.96 1/min * m(2), Group 2: from 1,57 to 1,89 and 2.00 1/min * m(2)). Conclusions: The short-term application of aePGI(2) shows a selective pulmonary vasodilation similar to NO. Given adequate monitoring, aePGI(2) appears to be useful for the acute treatment of PHT.