Abstract
A 33-year-old-man had severe secondary pulmonary hypertension due to perivalvular leakage at the aortic and mitral positions after aortic and mitral valve replacement. Preoperative cardiac catheterization revealed pulmonary artery pressure of 105/45 mmHg and pulmonary vascular resistance of 929 dynes·s·cm−5 To save the patient, we performed aortic and mitral valve re-replacement, and tricuspid annuloplasty. After surgery, selective pulmonary vasodilators, beraprost sodium, inhaled nitric oxide, and intravenous prostaglandin (PG) I2 were administered because of persistent severe pulmonary hypertension. Cardiac catheterization on postoperative day 58 showed that the pulmonary artery pressure and pulmonary vascular resistance had decreased to 40/20 mmHg and 87.7 dynes·s·cm−5, respectively The simultaneous use of inhaled nitric oxide, intravenous PGI2, and oral beraprost sodium might be useful for treating postoperative persistent pulmonary hypertension.
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References
Costard-Jäckle A, Fowler MB. Influence of preoperative pulmonary artery pressure on mortality after heart transplantation: testing of potential reversibility of pulmonary hypertension with nitroprusside is useful in defining a high risk group. J Am Coll Cardiol 1992;19:48–54.
Downing SW, Edmunds LH Jr. Release of vasoactive substances during cardiopulmonary bypass. Ann Thorac Surg 1992;54:1236–1243.
Moraes DL, Colucci WS, Givertz MM. Secondary pulmonary hypertension in chronic heart failure: the role of the endothelium in pathophysiology and management. Circulation 2000; 102:1718–1723.
Frostell C, Fratacci MD, Wain JC, Jones R, Zapol WM. Inhaled nitric oxide: a selective pulmonary vasodilator reversing hypoxic pulmonary vasoconstriction. Circulation 1991;83:2038–2047. Erratum: Circulation 1991;84:2212.
Roberts JD, Polaner DM, Lang P, Zapol WM. Inhaled nitric oxide in persistent pulmonary hypertension of the newborn. Lancet 1992;340:818–819.
Barst RJ, Rubin LJ, Long WA. A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension, N Engl J Med 1996;334:296–301.
Luttmann W, Herzog V, Matthys H, Thierauch KH, Virchow JC, Kroegel C. Modulation of cytokine release from mononuclear cells by prostacyclin, IL-4 and IL-13. Cytokine 1999;11:127–133.
Meja KK, Barnes PJ, Giembycz MA. Characterization of the prostanoid receptor(s) on human blood monocytes at which prostaglandin E2 inhibits lipopolysaccharide-induced tumour necrosis factor-alpha generation. Br J Pharmacol 1997;122: 149–157.
Durongpisitkul K, Laoprasitiporn D, Layangool T, Sittiwankul R, Panamonta M, Mokrapong P; Thailand Multicenter Study. Comparison of the acute pulmonary vasodilating effect of beraprost sodium and nitric oxide in congenital heart disease. Circ J 2005;69:61–64.
Egashira K. Molecular mechanisms mediating inflammation in vascular disease: special reference to monocyte chemoattractant protein-1. Hypertension 2003;41:834–841.
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Miura, T., Nishida, H., Kawai, A. et al. Successful treatment of a patient with severe pulmonary hypertension due to perivalvular leakage at aortic and mitral positions after aortic and mitral valve replacement. Gen Thorac Cardiovasc Surg 56, 521–525 (2008). https://doi.org/10.1007/s11748-008-0283-2
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DOI: https://doi.org/10.1007/s11748-008-0283-2