الفهرس | Only 14 pages are availabe for public view |
Abstract In spite the great improvement in the intensive care management for cases of left to right shunt with pulmonary hypertension and understanding a lot about pathophysiology of pulmonary hypertension and the use of recent medications and methods to prevent and treat its hazards, it still has less satisfactory outcome after closure in comparison to cases with lower pulmonary artery pressure. In this study we evaluated the effect of usage of pulmonary antihypertensive drugs on the pulmonary artery pressure after surgical closure of VSD. To detect the effect of pulmonary antihypertensive drugs, we divided our patients into 2 groups. The first group included 60 patients who received only the anti-failure drugs and the second group included 60 patients who received the same drugs in addition to selective pulmonary vasodilators. Pulmonary hypertension in pediatric patients with left to right shunts remains one of the most important determinants of perioperative morbidity and mortality. Sildenafil is an orally active inhibitor of PDE-5, inducing vasodilation and exhibiting antiproliferative effects through the NO/cyclic guanosine monophosphate pathway within the pulmonary vasculature. In 2011, sildenafil received EMA approval for use in children >1 year of age. [95] Tadalafil, an oral, selective PDE-5 inhibitor with a longer duration of action than sildenafil, was FDA-approved for use in adults with PAH Summary 82 in 2009. Although there is no published RCT data on the use of tadalafil in pediatric PAH, tadalafil started to be utilized in older children with similar efficacy in the era of FDA warning against the (chronic) use of sildenafil in children with PAH between 1 and 17 years of age in 2013, which was clarified in 2014 (“no contraindication” for pediatric use of sildenafil, but it has been used to a lesser extent in young infants. [96] All patients were subjected to pre, intra and postoperative studies with follow up visit after 3 months. Correlations between the preoperative, operative and postoperative data were presented with concentration on the effect of pulmonary antihypertensive drugs on postoperative pulmonary artery pressure. In our study, patients who received selective pulmonary vasodilators showed marked decrease in pulmonary pressure, ventilation time, ICU stay and hospital stay. The incidence of pulmonary hypertensive crises and mortality was also lower in patients who received these drugs but without statistical significance. |