Experience with Inhaled Iloprost Used in the Surgical Treatment of Chronic Postthromboembolic Pulmonary Hypertension
https://doi.org/10.15360/1813-9779-2013-2-35
Abstract
The paper describes a case of inhaled iloprost use in a female patient with severe respiratory failure after pulmonary artery thromboendarterectomy, who was on venovenous extracorporeal membrane oxygenation. To reduce pulmonary hypertension and to prevent reperfusion syndrome, the patient received inhaled iloprost in a dose of 5 ^g every 3 hours during surgery and in the first two days after surgery. On day 14 after surgery, extracorporeal membrane oxygenation was stopped as there were satisfactory respiratory and hemodynamic parameters. Four days later, the patient was weaned from mechanical ventilation. The length of stay in the intensive care unit was 24 days. The patient was discharged from hospital in a satisfactory condition. Thus, the perioperative use of iloprost could reduce pulmonary artery pressure by twice; however, reperfusion syndrome could not prevent significant respiratory failure. The data available in the literature on the use of ilo-prost in patients after pulmonary artery thromboendarterectomy are single and their results are ambiguous. There is a need for large-scale multicenter studies in this group of patients. Key words: chronic postthromboembolic pulmonary hypertension, pulmonary artery thromboendarterectomy, iloprost, extracorporeal membrane oxygenation.
About the Authors
V. V. Lomivorotov
Academician E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk
M. N. Deryagin
Academician E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk
S. M. Efremov
Academician E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk
V. A. Shmyrev
Academician E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk
I. A. Kornilov
Academician E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk
A. M. Chernyavsky
Academician E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk
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3. Moser K.M., Bloor C.M.Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension.Chest.1993; 103 (3): 685—692.
4. Riedel M., Stanek V., Widimsky J., Prerovsky I.Long-term follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data.Chest.1982; 81 (2): 151 — 158.
5. Riedel B.The pathophysiology and management of perioperative pulmonary hypertension with speci?c emphasis on the period following cardiacsurgery.Int. Anesthesiol. Clin.1999; 37 (2): 55—79.
6. GalieN., HoeperM.M., HumbertM., Torbicki A., VachieryJ.L., Barbera JA., Beghetti M., Corris P., Gaine S., Gibbs J.S., Gomez-Sanchez M.A., Jondeau G., Klepetko W., Opitz C., Peacock A., Rubin L., Zellweger M., Simonneau G.; ESC Committee for Practice Guidelines (CPG).Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT).Eur. Heart. J.2009; 30 (20): 2493—2537.
7. Channick R.N., Simonneau G., Sitbon O., Robbins I.M., Frost A., Tapson V.F., Badesch D.B., Roux S., Rainisio M., Bodin F., Rubin L.J.Effects of the dual endothelin-receptor antagonist bosentan in patients with pulmonary hypertension: A randomized placebo-controlled study.Lancet.2001; 358 (9288): 1119—1123.
8. Lewis G.D., Shah R., Shahzad K., Camuso J.M., Pappagianopoulos P.P., HungJ., TawakolA., Gerszten R.E., Systrom D.M., Bloch K.D., Semigran MJ.Sildenafil improves exercise capacity and quality of life in patients with systolic heart failure and secondary pulmonary hypertension.Circulation.2007; 116 (14): 1555—1562.
9. Moser K.M., Rhodes P.G., Hufnagel C.C.Chronic unilateral pulmonary artery thrombosis — successful thrombendarterectomy with thirty-month follow-up observation.N. Engl. J. Med.1965; 272: 1195—119
10. Thistlethwaite P.A., Kaneko K., Madani M.M., Jamieson S.W.Techniques and outcomes of pulmonary endarterectomy surgery.Ann. Thorac. Cardiovasc. Surg.2008; 14 (5): 274—282.
11. Dartevelle P., Fadel E., Mussot S., Chapelier A., Herve P., Perrot M., CerrinaJ., Ladurie F.L., Lehouerou D., HumbertM., Sitbon O., Simonneau G.Chronic thromboembolic pulmonary hypertension.Eur. Respir. J.2004; 23 (4): 637—648.
12. Ломиворотов В.В., Фоминский Е.В., Непомнящих В.А., Ефремов С.М., Чернявский А.М., Ломиворотов В.Н., Шилова А.Н., Караськов А.М.Влияние раствора хлорида натрия и гидроксиэтилкрахмала (200/0,5) на функцию легких и гемодинамику больных, оперированных с искусственным кровообращением.Общая реаниматология.2012; 8 (5): 38—46.
13. Мороз В.В., Лихванцев В.В., Гребенчиков О.А.Современные тенденции в развитии анестезиологии.Общая реаниматология.2012; 8 (4): 118—122.
14. Jamieson S.W., Kapelanski D.P.Pulmonary endarterectomy.Curr. Probl. Surg.2000; 37 (3): 165—252.
15. Thistlethwaite P.A., Madani M.M., Jamieson S.W.Pulmonary throm-boendarterectomy surgery.Cardiol. Clin.2004; 22 (3): 467—478.
16. de Perrot M., Liu M., Waddell T.K., Keshavjee S.Ischemia-reperfu-sion-induced lung injury.Am. J. Respir. Crit. Care Med.2002; 167 (4): 490—511.
17. ГолубевА.М., МорозВ.В., СундуковД.В.Патогенез острого респираторного дистресс-синдрома.Общаяреаниматология.2012; 8 (4): 13—21.
18. Imanaka H., Miyano H., Takeuchi M., Kumon K., Ando M.Effects of nitric oxide inhalation after pulmonarythromboendarterectomy for chronic pulmonary thromboembolism.Chest.2000; 118 (1): 39—46.
19. Madani M.M., JamiesonS.W. An insider’s guide to pulmonary throm-boendarterectomy: proven techniques to achieve optimalResults.Adv. Pulmonary Hypertension.2003; 2: 13—20.
20. Limsuwan A., Wanitkul S., Khosithset A., Attanavanich S., Samankatiwat P.Aerosolized iloprost for postoperative pulmonary hypertensive crisis in children with congenital heart disease.Int. J. Cardiol.2008; 129 (3): 333—338.
21. Rex S, Schaelte G, Metzelder S., Flier S., de Waal E.E., Autschbach R., Rossaint R, Buhre W.Inhaled iloprost to control pulmonary artery hypertension in patients undergoing mitral valve surgery: a prospective, randomized-controlled trial.Acta Anaesthesiol. Scand.2008; 52 (1): 65—72.
22. Bigot A., Jonville-Bera A.P., Diot E., Magro P., Diot P.Periprandial administration of inhaled iloprost: a risk factor for digestive bleeding?Br.J. Clin. Pharmacol.2012; 73 (3): 484-485.
Review
For citations:
Lomivorotov V.V., Deryagin M.N., Efremov S.M., Shmyrev V.A., Kornilov I.A., Chernyavsky A.M. Experience with Inhaled Iloprost Used in the Surgical Treatment of Chronic Postthromboembolic Pulmonary Hypertension. General Reanimatology. 2013;9(2):35. (In Russ.) https://doi.org/10.15360/1813-9779-2013-2-35
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