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Inhaled iloprost for testing vasodilator capacity in secondary pulmonary hypertension in children with congenital heart disease: 022

Raileanu, I.; Filipescu, D.; Luchian, M.; Ghenu, O.; Cristea, M.; Marin, S.; Gheorghiu, I.; Platon, P.; Bradisteanu, S.; Tulbure, D.

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 33

Introduction: The assessment of pulmonary vascular reactivity plays an important role in the management of patients with pulmonary hypertension (PHT) related to congenital heart disease. Inhaled iloprost, a stable prostacyclin analogue, may be an alternative to inhaled nitric oxide for early testing of vascular reactivity and for perioperative treatment of PHT [1]. We present the first cases in which we used inhaled iloprost to test pulmonary vascular reactivity.

Method: Three children with congenital heart disease (1st. and 2nd. with ventricular septal defect, 3rd. with aortopulmonary window) and high values of pulmonary vascular resistance were first given oxygen for 10 minutes. After baseline values were reached again, they were given inhaled iloprost at a concentration of 4 μg/mL with an average nebulization rate of 0.6 mL/min for 5 minutes. Haemodynamic data were recorded before and after each treatment.

Results: Baseline and after oxygen and iloprost administration haemodynamics are given in Table 1.

Table 1
Table 1:
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In patient 1 and 2, PVR decreased after O2 as well as after iloprost administration. The intracardiac shunt Qp/Qs increased due to a decrease of Rp/Rs. In patient 3 PVR decreased after O2 but not after iloprost.

Conclusion: The present report of a small number of cases is by no means conclusive, but raises the possibility that inhaled iloprost may decrease the pulmonary vascular resistance in patients with PHT related to congenital heart disease.


1 Rimensberger PC, Spahr-Schopfer I, Berner M, et al. Inhaled nitric oxide versus aerosolized iloprost in secondary pulmonary hypertension in children with congenital heart disease: vasodilator capacity and cellular mechanisms. Circulation 2001; 103: 544-548.
© 2004 European Society of Anaesthesiology