Flores medical - multisonic - Inhalation mit Ultraschall

Patients with cardiac defects

POSTOPERATIVE PULMONARY HYPERTENSION IN PATIENTS WITH CARDIAC DEFECTS

Both congenital shunts in babies and heart valve defects in adults are, if sufficiently severe, volume and pressure loads to the pulmonary arteries. The resulting endothelial damage is associated with an imbalance of mediators such as thromboxane and prostacyclin as well as with such vascular irregularities as seen in PAH.

High pulmonary artery pressure may persist after corrective cardiac surgery. The operation with trauma and hypoxia alone as well as the heart-lung machine induce release of vasoactive and pro-inflammatory substances. This creates the risk of acute pulmonary hypertensive crises and of right ventricular de-compensation. Postoperative pulmonary hypertension is a major risk factor for cardiac surgery mortality.

Postoperative management therefore aims to prevent critically high pulmonary arterial pressure. For reasons of controllability and time of onset of action, only parenterally administered vasodilatators are given. Only intravenous prostanoids and inhaled vasodilatators decrease right-ventricular afterload, whereas NO-substances reduce cardiac preload and PDE-3-inhibitors affect contractility. Major problems with administration of inhaled NO include inconvenient handling and application safety.

Several casuistries and studies involving a small number of patients have supported the assumption that inhaled iloprost causes a potent and selective reduction of pulmonary artery pressure in postoperative cardiac surgery patients. Improved pulmonary haemodynamics led to stabilization of blood circulation and partially shorter ventilation times and let the patients do well postoperatively without any complications. Iloprost is considered a good alternative to administration of NO. Aside from the more effective vasodilatation compared to that induced with NO, the results of these studies indicate that inhaled iloprost is well tolerated and easy to use.