Intraoperative inhalation of the long-acting prostacyclin analog iloprost for pulmonary hypertension

Abstract

Pulmonary hypertension (PHT) contributes significantly to morbidity and mortality in cardiac surgery—especially in patients with long-standing mitral valve disease. Vasodilators administered intravenously can reduce pulmonary vascular resistance but also have an effect on the systemic circulation. Arterial hypotension must be expected, which results in reduction of right coronary blood flow and may lead to further deterioration of right ventricular performance. Inhaled nitric oxide (NO) is a more selective pulmonary vasodilator with virtually no systemic side effects. Recently, the inhalational use of the long-acting prostacyclin analog iloprost has been reported to offer superior selective pulmonary vasodilating properties relative to NO inhalation in primary PHT. We report our initial experience with the intraoperative use of iloprost inhalation in a case series of cardiac surgical patients.