Intravenous iloprost treatment for patients underwent total cavopulmonary connection in the early postoperative period

Abstract

Objective To explore the results of postoperative intravenous Iloprost for patients underwent total cavopulmonary connection(TCPC).Methods From January to December of 2008,44 patients who underwent TCPC were treated with intravenous Iloprost in Shanghai Children's Medical Center.The method of administration of Iloprost was continuous 24-hour intravenous infusion,and the dosage ranged from 3 ng·kg-1 ·min-1 to 10 ng·kg-1 ·min-1.The treatment indication included postoperative transpulmonary pressure (TPG)≥ 10 mmHg,and/or central venous pressure(CVP)≥20 mmHg,and/or hypoxemia,and/or unstable circulation.Results Before administration,TPG was ( 14.5 ± 2.7) mmHg,CVP was ( 19.8 ± 5.2) mmHg,PaO2/FiO2 (P/F) ratio was 117.6 ± 68.0,Systolic arterial blood pressure(SABP) was (70.7 ± 16.3)mmHg,respectively.At the timing of extubation (during the course of administration),TPG was 9.5 ± 2.3 mmHg,CVP was (12.4 ± 2.6)mmHg,P/F ratio was 182.1 ± 115.2,SABP was (105.8± 13.5)mmHg,respectively.TPG and CVP decreased by (39.6± 1.1)％ and (38.7 ± 9.8)％,while the P/F ratio and SABP increased by 65.3 ±39.5 and (32.6±21.3)％,repectively.Thirty minutes after extubation,TPG was (8.1± 1.9)mmHg,CVP was ( 11.4 ± 2.4 ) mmHg,P/F ratio was 229.6 ± 165.1,SABP was ( 111.3 ± 12.3) mmHg,repectively.TPG and CVP decreased by (51.3 ± 17.2)％ and (44.4 ± 10.5)％,while the P/F ratio and SABP increased by 92.6± 49.2 and (42.5 ± 15.3) ％,respectively.Conclusions Continuous 24-hour intravenous infusion of Iloprost is an effective treatment for selective reduction of pulmonary vascular resistance for TCPC patients in the early postoperative period. Key words: Iloprost; Vascular resistance; Cardiac output