Iloprost Inhalation Research Articles

Acute effect of iloprost inhalation on right atrial function and ventricular dyssynchrony in patients with pulmonary artery hypertension

Right atrium function and ventricular function have significant prognostic value in pulmonary arterial hypertension patients. Acute changes in right ventricular synchrony and right atrium function postiloprost inhalation have not been evaluated. Cross-sectional study. Consecutive pulmonary arterial hypertension patients (group I from Nice classification) were included. Echocardiographic right atrium and right ventricular function pre- and postiloprost inhalation, including a right ventricular dyssynchrony index and right atrium function using speckle tracking, were performed in all patients. Twenty pulmonary arterial hypertension patients, 44±7years and 90% females, were included. After iloprost inhalation, we observed a significant increment in right ventricular fractional area change and a significant decrease in right ventricular dyssynchrony index (21.4±5.6% vs 26.1±4.0%, P=.007 and 79±44 vs 32±22mseconds, P<.01, respectively), also an improvement in right atrium reservoir function (8.6±3.1% vs 11.7±3.5%, P=.002). Iloprost inhalation induces acute changes in right ventricular function, dyssynchrony, and right atrium performance that may add relevant clinical information in the management and risk stratification of pulmonary arterial hypertension patients.

Acute improvement of pulmonary hemodynamics does not alleviate Cheyne-Stokes respiration in chronic heart failure-a randomized, controlled, double-blind, crossover trial.

This randomized, controlled trial aimed to investigate whether acute improvement of pulmonary congestion would reduce the severity of Cheyne-Stokes respiration (CSR) in patients with chronic heart failure (CHF). Twenty-one consecutive patients with CHF and CSR (apnea-hypopnea index [AHI] ≥15/h) underwent right heart catheterization with titration of intravenous (IV) glyceryltrinitrate (GTN) to a maximum tolerable dosage and inhalation of iloprost 10μg/mL after a washout phase. Maximum tolerable dosages of GTN and iloprost were randomly applied during full cardiorespiratory polysomnography within two split-night procedures and compared with IV or inhaled sodium chloride (NaCl) 0.9%, respectively. GTN (6.2 ± 1.5mg/h) and iloprost significantly lowered \mean pulmonary artery pressure (20.1 ± 9.0 to 11.6 ± 4.2mmHg, p < 0.001 and 16.9 ± 7.9 to 14.2 ± 6.4mmHg, p < 0.01, respectively). Pulmonary capillary wedge pressure was only reduced by GTN (14.0 ± 5.6 to 7.2 ± 3.9mmHg, p < 0.001), and there was no significant change in the cardiac index. Sleep studies revealed no significant improvement in markers of CSR severity, including AHI, central apnea index, and CSR cycle length following GTN or iloprost treatment. Significant decreases in blood pressure, mean oxygen saturation, and S3 sleep were documented during GTN infusion. Acute improvement of pulmonary congestion by GTN had no immediate impact on CSR severity. Future investigations must therefore include longer treatment periods and treatment regimens that have positive, rather than negative, additional effects on peripheral and central chemoreceptors and sleep structure. German Clinical Trial Registry-ID:DRKS00000467 ( www.germanctr.de ).

About choosing a vasodilator for vasoreactivity tests in heart transplant candidates

The purpose of our prospective, consistent, non-randomized study was to analyze the results of vasoreactivity tests (VRT) performed with nitric oxide (NO) or inhaled Iloprost in heart transplant candidates. 72 VRTs were done in 58 candidates for heart transplantation. All patients had heart failure III-IV NYHA and pulmonary hypertension (PH) with pulmonary vascular resistance (PVR) over 2.5 WU. 43 patients received NO, 80 ppm for 20 min. 29 patients inhaled 20 g of Iloprost (Ventavis, Bayer). Hemodynamic parameters were measured at baseline, 20 min after NO inhalation and 15 min following the completion of Iloprost inhalation. There were no between-group differences in the severity of patient's condition and baseline hemodynamic indicators. Both vasodilators caused statistically significant reduction in mean PAP: in the NO group it dropped (p = 0.002), in the Iloprost group the mean PAP decreased (p&lt;0.0001). A more than 20% decrease in PAP was recorded in 13 cases (30.2%) in the NO group and in 16 cases (55.2%) in the Iloprost group (p = 0.03). A more than 20% decrease in PVR was noted in 24 cases (55.8%) in the NO group and in 24 cases (82.8%) in the Iloprost group (p&lt;0.02). We found some differences in the effect of NO and Iloprost on LV efficiency. There were no changes in the stroke volume index (SVI) in the NO group, while inhaled Iloprost increased SVI (p&lt;0.001). A probable cause of the increase in LV efficiency might have been the reduction of total peripheral vascular resistance (p&lt;0.0001). There were no differences in SVI during NO inhala-tion. It should be noted in conclusion that Iloprost is more effective in decreasing mean PAP and PVR in heart transplant candidates. Inhaled Iloprost causes favorable changes in preload and afterload of the impaired LV and increases its performance.

Acute response of right ventricular function to iloprost inhalations in patients with pulmonary arterial hypertension: preliminary evaluation with cardiac magnetic resonance imaging

背景与目的肺动脉高压（pulmonary arterial hypertension, PAH）是以肺循环压力异常增高为特征的进展性疾病，可引起右心室（right ventricle, RV）功能进行性衰竭，最终导致死亡。因此RV功能的评估在PAH的诊断、随访中起着重要作用。心脏磁共振成像（cardiac magnetic resonance imaging, CMRI）成为无创评价心室功能的参照标准，尤其是RV功能。本研究通过CMRI评估吸入伊洛前列素对PAH患者RV功能影响的即刻效应。方法2012年3月-2014年3月PAH患者48例，吸入单剂量20 μg的伊洛前列素溶液前、后立即进行CMRI检查，测量RV的舒张末期容积（end-diastolic volume, EDV）、收缩末期容积（end-systolic volume, ESV）、每搏输出量（stroke volume, SV）、射血分数（ejection fraction, EF）、心输出量（cardiac output, CO）、舒张末期面积（end-diastolic area, EDA）及收缩末期面积（end-systolic area, ESA）。RV面积变化百分比（percentage of RV area change, %RVAC）由公式[%RVAC=（EDA-ESA）/EDA×100%]计算获得。采用Wilcoxon符号秩和检验或配对t检验分析吸入伊洛前列素前、后RV功能参数变化。P＜0.05为差异有统计学意义。结果吸入伊洛前列素后，患者的RV功能改善，RV EDV、RV ESV显著下降（P=0.007, P＜0.001），RV SV、RV EF及%RVAC增加（P=0.014, P=0.009, P=0.006），RV CO无变化（P=0.851）。结论吸入伊洛前列素能立即明显改善PAH患者的RV功能，CMRI能准确、无创地评估该即刻效应。

Acute hemodynamic response of infused fasudil in patients with pulmonary arterial hypertension: A randomized, controlled, crossover study

BackgroundThe Rho-kinase pathway has been shown to be involved in the pathogenesis of PAH. As yet, however, the acute effects of the Rho-kinase inhibitor fasudil have not been compared with established pulmonary selective vasodilators in patients with PAH. We compared the acute effects of intravenous fasudil with inhaled iloprost in patients with pulmonary arterial hypertension (PAH). MethodsUsing a crossover design, 50 patients with PAH (idiopathic PAH, PAH associated with repaired left-to-right cardiac shunts, or connective tissue disease) were randomized to iloprost inhalation (5μg) and intravenous fasudil (30mg over 30min). Hemodynamic data were collected at baseline and during acute drug exposure. ResultsComparable decreases were observed in mean pulmonary artery pressure (−4.6±4.3mmHg vs. −4.8±4.2mmHg) and pulmonary vascular resistance (−3.0±3.0 Wood U vs. −2.2±2.7 Wood U) with fasudil infusion and iloprost inhalation, respectively, during acute challenge. However, fasudil infusion resulted in a more pronounced increase in mean cardiac output and mixed venous oxygen saturation compared with iloprost inhalation (13.7±17.1% vs. 6.9±15.0%; p=0.044 and 4.5±5.3% vs. 2.7±8.2%; p=0.044, respectively). Whereas inhaled iloprost resulted in a non-significant increase in mean systemic arterial oxygen saturation (0.8±3.6%), infused fasudil resulted in a non-significant reduction (−0.6±1.1%). ConclusionInfused fasudil improved pulmonary hemodynamics in patients with PAH without significant toxicity.

Disease Activity Is Related to Acute Response to Vasodilator in Pulmonary Artery Hypertension Associated With Systemic Lupus Erythematosus

No previous study has been done on whether systemic lupus erythematosus (SLE) disease activity is related to the hemodynamics and right ventricular (RV) function in patients with SLE-associated pulmonary artery hypertension (SLE-APAH). This study prospectively recruited 54 patients (mean age, 32.8±8.4 years; 92.6% female) with SLE-APAH, including 34 patients with SLE disease activity index (SLEDAI) <5 (low score) and 20 with SLEDAI ≥5 (high score). All patients underwent right heart catheterization and iloprost inhalation, and echocardiography was performed before and immediately after iloprost inhalation. There was no difference in baseline mean pulmonary artery pressure (mPAP) between the 2 groups; pulmonary vascular resistance (PVR) was significantly higher and cardiac index was significantly lower in the low-SLEDAI group. The patients with low SLEDAI had larger RV size and worse RV systolic function on echocardiography. After iloprost inhalation, the patients with low SLEDAI had a greater decrease in mPAP and PVR than those with high SLEDAI, while significantly increased RV systolic function was found only in the low-SLEDAI group. SLE activity is related to hemodynamics and RV function in SLE-APAH patients, and those with low SLEDAI might have better acute response to vasodilator inhalation.

Inhaled iloprost for the treatment of patient with Fontan circulation.

Decreased exercise capacity after Fontan surgery is relatively common and the failure of the Fontan state gradually increases with age. However, there is no further treatment for patients with Fontan circulation. Pulmonary vasodilation therapy is an effective method to solve this problem because pulmonary vascular resistance is a major factor of the Fontan problem. Inhaled iloprost is a chemically stable prostacyclin analogue and a potent pulmonary vasodilator. We experienced two cases of Fontan patients treated with inhaled iloprost for 12 weeks. The first patient was an 18-year-old female with pulmonary atresia with an intact ventricular septum, and the second patient was a 22-year-old male with a double outlet right ventricle. Fifteen years have passed since both patients received Fontan surgery. While the pulmonary pressure was not decreased significantly, improved exercise capacity and cardiac output were observed without any major side effects in both patients. The iloprost inhalation therapy was well tolerated and effective for the symptomatic treatment of Fontan patients.

The Effects of Perioperative Inhaled Iloprost on Pulmonary Hypertension with Congenital Heart Disease

Objectives: The treatment of choice for congenital heart disease (CHD) with pulmonary arterial hypertension (PAH) is still controversial. We assessed the efficacy and safety of perioperative inhaled iloprost therapy in CHD with PAH. Methods: Among 45 patients with a ventricular septal defect and/or an atrial septal defect with PAH, 28 patients were treated with inhaled iloprost before and after surgery. Perioperative clinical parameters and plasma B-type natriuretic peptide (BNP) were evaluated. Results: No statistical difference in the estimated right ventricular systolic pressure (e-RVP), the e-RVP-to-systemic pressure ratio, and preoperative BNP levels between the iloprost group and the control group were found. Among the iloprost group, oxygen saturation was increased significantly after iloprost inhalation therapy (p = 0.0052). The iloprost group was also significantly correlated with less use of inhaled nitric oxide in the immediate postoperative period compared to the control group (p = 0.021). The durations of mechanical ventilation (p = 0.018), ICU stay (p = 0.005), and chest tube use (p = 0.039) were significantly shorter in the iloprost group compared to the control group. The plasma BNP, checked on 7th day of postoperatively, was lower in the iloprost group than in the control group (p = 0.008). Conclusion: Perioperative inhaled iloprost therapy showed the benefit of cardiac functional improvement and early weaning of postoperative supportive care in the management of CHD with PAH.

GW24-e2157 The acute hemodynamic responses of pulmonary arterial hypertension associated with congenital heart disease to iloprost

ObjectivesPulmonary arterial hypertension (PAH) is the commonest complication of left-to-right shunt congenital heart disease (CHD). Detection of pulmonary vascular reactivity is important for the evaluation of patient with PAH. This...

ASSA13-17-2 The Acute Hemodynamic Responses of Pulmonary Arterial Hypertension Associated with Congenital Heart Disease to Iloprost

<h3>Background</h3> Pulmonary arterial hypertension (PAH) is the commonest complication of left-to-right shunt congenital heart disease (CHD). Detection of pulmonary vascular reactivity is important for the evaluation of patient with PAH. <h3>Objective</h3> This study aimed to investigate the acute hemodynamic responses to iloprost in patients with idiopathic PAH (IPAH) and PAH associated with systemic-to–pulmonary shunt CHD (PAH-CHD). <h3>Methods</h3> This study included a cohort of patients with IPAH and PAH-CHD. The inclusion criteria were: ➀ IPAH with pulmonary artery systolic pressure &gt; 70mmHg measured by catheter and ➁ PAH-CHD with pulmonary artery systolic pressure &gt; 70mmHg and pulmonary-to-systemic flow ratio (Qp/Qs) &lt;1.5. After determination of baseline haemodynamic parameters by cardiac catheterization, 10μg of aerosol iloprost was inhaled and right heart catheterization was repeated. <h3>Results</h3> A total of 165 patients (118 females) aged 29 ± 13 years were recruited, including 24 with IPAH and 141 with PAH-CHD. There were 2 acute positive responders (8.3%) in patients with IPAH who benefited from the treatment of calcium antagonist thereafter. No positive responder was found in patients with PAH-CHD. Inhalation of aerosol iloprost induced significant decrease in pulmonary artery pressure (<i>P</i> &gt; 0.01), pulmonary vascular resistance (<i>P</i> &lt; 0.01) and pulmonary-to-systemic vascular resistance ratio (<i>P</i> &lt; 0.05) in patients with both IPAH and PAH-CHD. However, significant increase in oxygen saturation of femoral blood was only observed in patient with PAH-CHD. A ≥10% decrease in both pulmonary vascular resistance and pulmonary-to-systemic vascular resistance ratio at the end of drug exposure was observed in 58.9% of patients with PAH-CHD had but only in 45.8% of patients with IPAH. <h3>Conclusions</h3> There are 8.3% of acute positive responders in patients with IPAH but no positive response in patients with PAH-CHD. Although iloprost induces decrease in pulmonary artery pressure and pulmonary vascular resistance in patients with patients with IPAH and PAH-CHD, the acute hemodanamic changes were different.

Acute Effects of Aerosolized Iloprost in COPD Related Pulmonary Hypertension - A Randomized Controlled Crossover Trial

BackgroundInhaled iloprost potentially improves hemodynamics and gas exchange in patients with chronic obstructive pulmonary disease (COPD) and secondary pulmonary hypertension (PH).ObjectivesTo evaluate acute effects of aerosolized iloprost in patients with COPD-associated PH.MethodsA randomized, double blind, crossover study was conducted in 16 COPD patients with invasively confirmed PH in a single tertiary care center. Each patient received a single dose of 10 µg iloprost (low dose), 20 µg iloprost (high dose) and placebo during distinct study-visits. The primary end-point of the study was exercise capacity as assessed by the six minute walking distance.ResultsBoth iloprost doses failed to improve six-minute walking distance (p = 0.36). Low dose iloprost (estimated difference of the means −1.0%, p = 0.035) as well as high dose iloprost (−2.2%, p<0.001) significantly impaired oxygenation at rest. Peak oxygen consumption and carbon dioxide production differed significantly over the three study days (p = 0.002 and p = 0.003, accordingly). As compared to placebo, low dose iloprost was associated with reduced peak oxygen consumption (−76 ml/min, p = 0.002), elevated partial pressure of carbon dioxide (0.27 kPa, p = 0.040) and impaired ventilation during exercise (−3.0l/min, p<0.001).ConclusionsImprovement of the exercise capacity after iloprost inhalation in patients with COPD-associated mild to moderate PH is very unlikely.Trial RegistrationControlled-Trials.com ISRCTN61661881

Hemodynamic Effects of Combination Therapy With Inhaled Nitric Oxide and Iloprost in Patients With Pulmonary Hypertension and Right Ventricular Dysfunction After High-Risk Cardiac Surgery

The purpose of this study was to evaluate the hemodynamic effects of inhaled nitric oxide (NO) plus aerosolized iloprost in patients with pulmonary hypertension/right ventricular dysfunction after cardiac surgery. A retrospective study. A single center. Eight consecutive patients with valve disease and postextracorporeal circulation (ECC) pulmonary hypertension/right ventricular dysfunction. The continuous inhalation of nitric oxide (10 ppm) and iloprost, 10 μg, in repeated doses. The hemodynamic profile was obtained before inhalation, during the administration of inhaled NO alone (prior and after iloprost), and after the first 2 doses of iloprost. Tricuspid annular velocity and tricuspid annular plane systolic excursion were estimated at baseline and before and after adding iloprost. At the end of the protocol, there were significant decreases in pulmonary vascular resistance (p < 0.001), the mean pulmonary arterial pressure (p < 0.001), and the mean pulmonary artery pressure/mean arterial pressure ratio (p = 0.006). Both tricuspid annular velocity (p < 0.001) and tricuspid annular plane systolic excursion (p < 0.001) increased. The cardiac index (p < 0.001) and venous blood oxygen saturation (p = 0.001) increased throughout the evaluation period. Each iloprost dose was associated with further decreases in pulmonary vascular resistances/pressure. By comparing data at the beginning of inhaled NO with those after the second dose of iloprost, the authors noticed decreases in pulmonary vascular resistances (p = 0.004) and the mean pulmonary artery pressure (p = 0.017) and rises in tricuspid annular velocity (p < 0.001) and tricuspid annular systolic plane systolic excursion (p < 0.001). Inhaled NO and iloprost significantly reduced pulmonary hypertension and contributed to the improvement in right ventricular function. Inhaled NO and iloprost have additive effects on pulmonary vasculature.

Iloprost Inhalation in Mild Asthma

Objective. To determine the feasibility of administering iloprost by inhalation in patients with mild atopic asthma. Methods. Volunteers underwent supervised inhalation of iloprost in the clinic with measurement of spirometry and blood pressure for 2 hours. The volunteers then inhaled iloprost four times daily at a dose of 2.5 or 5 μg for 14 days. Spirometry, asthma questionnaires, peak flow diaries, measurement of methacholine responsiveness, and exhaled nitric oxide concentrations were obtained prior to and after the treatment period. Results. Chronic inhalation of iloprost (2.5–5 μg) did not alter spirometry or methacholine responsiveness. Conclusion. Inhaled iloprost in carefully selected volunteers with mild asthma appears to be a suitable intervention to explore the effects of prostacyclin in human asthma.

Inhaled Low‐Dose Iloprost for Pulmonary Hypertension: A Prospective, Multicenter, Open‐Label Study

Inhaled iloprost (average >30 µg/d) has been considered an effective treatment for severe pulmonary hypertension (PH). Further evidence also showed that low-dose iloprost given intravenously was equally effective as high-dose iloprost in the therapy of systemic sclerosis. Patients with pulmonary hypertension will benefit from inhalation of low-dose iloprost. Sixty-two patients with PH were enrolled and initiated with neubulizedlow-dose iloprost (2.5 µg per inhalation, 6× daily) for 24 weeks in 13 medical centers in China. Efficacy endpoints included changes in 6-minute walk distance (6MWD), World Health Organization functional class (WHO-FC), and hemodynamic parameters. Fourteen patients (22.6%) prematurely discontinued the study: 8 due to clinical worsening (6 in WHO-FCIII-IV at baseline), 4 because of protocol change, and 2 patients lost during follow-up. In the remaining 48 patients, 6MWD was increased from 356 ± 98 meters to 414 ± 99 meters (P < 0.001) and WHO-FC improved significantly (P = 0.006) after 24-week inhalation therapy. Cardiac output, cardiac index, and mixed venous oxygen saturation improved significantly compared with baseline (n = 34, P < 0.05). Most of the hemodynamic parameters improved significantly in patients in WHO-FC II (P < 0.05) but not in patients in WHO-FCIII-IV. Low-dose iloprost inhalation significantly improved exercise capacity and functional status in patients with PH. It was well tolerated. The improvement of hemodynamics was confirmed in patients with WHO-FCI-II but not in patients with WHO-FCIII-IV, suggesting the importance of early treatment in patients with advanced disease stages.

Periprandial administration of inhaled iloprost: a risk factor for digestive bleeding?

Periprandial administration of inhaled iloprost: a risk factor for digestive bleeding?

Effects of inhaled aerosolized iloprost in adult patients with pulmonary arterial hypertension on right heart functions

To explore the immediate effects of inhaled aerosolized iloprost on right heart function in adult patients with pulmonary arterial hypertension (PAH). A total of 30 PAH patients were recruited. Right heart catheterization and echocardiography were performed before and immediately after the inhalation of iloprost (20 µg). After inhalation, the values of mean pulmonary artery pressure (PAPm) and pulmonary vascular resistances (PVR) decreased markedly (42.5 ± 9.6 to 34.4 ± 11.9 mm Hg, P < 0.001; 9.6 ± 5.7 Wood unit to 7.1 ± 4.8 Wood unit, P < 0.001). And the value of tricuspid annular systolic motion peak velocity (TASm) increased markedly [(10.7 ± 2.1) cm/s vs (11.9 ± 2.5) cm/s, P < 0.01]. The baseline level of TASm was higher in acute responders than non-responders [(12.0 ± 2.2) cm/s vs (10.1 ± 1.8) cm/s, P = 0.01] and TASm increased markedly after inhalation in non-responders [(10.1 ± 1.8) cm/s vs (11.6 ± 2.3) cm/s, P < 0.01]. The inhalation of iloprost decreases the levels of PAPm and PVR and improve right heart functions in adult PAH patients. For non-responders, right heart function is worse and more benefits may be achieved after the inhalation of iloprost.

Inhaled Iloprost for Patients With Precapillary Pulmonary Hypertension and Right-Side Heart Failure

Background Pulmonary hypertension (PH) can lead to right-side heart failure (RHF) and death. There are no therapeutic recommendations for patients experiencing acute RHF in the course of PH. This study aimed to examine the safety and efficacy of inhaled iloprost in patients with precapillary PH and RHF. Methods and Results Between October 2007 and December 2008, 7 patients with precapillary PH and RHF were enrolled. Per protocol, iloprost was inhaled hourly for a minimum of 12 hours during a 24-hour period. The starting dose of 2.5 μg was increased hourly by 2.5 μg as long as the increases were tolerated. Safety and efficacy were determined by continuous invasive monitoring of systemic and pulmonary hemodynamic parameters. Systemic pressures remained stable during inhalation (66.1 ± 6.9 mm Hg at baseline and 69.1 ± 6.4 mm Hg immediately after inhalation therapy, P = 0.48). Cardiac index increased from 2.4 ± 0.7 L/min/m 2 to 2.9 ± 0.9 L/min/m 2 ( P = .008). Pulmonary vascular resistance decreased from 634.6 ± 218.3 dyn·s·cm −5 to 489.6 ± 173.8 dyn·s·cm −5 ( P = .044), and N-terminal B-type natriuretic peptide levels decreased from 13,591 ± 10,939 pg/mL to 9,944 ± 8,569 pg/mL ( P = .051). Conclusion Blood pressure-guided hourly inhalation of iloprost may offer a safe and effective strategy for the treatment of PH patients with RHF.

Effective Treatment of Pulmonary Hypertension With Inhaled Iloprost in a Patient With Severe Bullous Emphysema

INTRODUCTION: Limited therapeutic options are available for treatment of pulmonary hypertension (PH) associated with chronic obstructive pulmonary disease (COPD). The use of non-selective systemic vasodilators resulted in worsening of gas exchange and symptoms in this patient population. Preliminary data suggests favorable acute effects on gas exchange and exercise tolerance after inhalation of Iloprost in a small case series of COPD patients with PH and right ventricular (RV) dysfunction.1 We report a case of severe PH in a patient with bullous emphysema who derived a significant functional and hemodynamic improvement following treatment with inhaled Iloprost.

Acute hemodynamic responses to adenosine and iloprost in patients with congenital heart defects and severe pulmonary arterial hypertension

Detection of pulmonary vasoreactivity is important for the evaluation of patient with pulmonary arterial hypertension (PAH). The present study aimed to investigate the acute hemodynamic responses to adenosine and iloprost in patients with congenital heart defects (CHDs) and severe PAH. From Mar 2007 to Nov 2009, 75 patients with severe PAH secondary to left-to-right shunt CHDs underwent acute vasodilator test using aerosolized iloprost (n = 50) or intravenous adenosine (n = 25). The hemodynamics were detected and analyzed. Decreased mean pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR) were observed in 39 and 43 patients in the iloprost group, and in 16 and 19 patients in the adenosine group, respectively. However, the mean PAP was higher than 40 mm Hg in both groups. No significant difference was observed in the age and baseline hemodynamics between the patients with the decrease of PVR and mean pulmonary-to-aortic pressure (Pp/Ps) ratio greater than 10% and the remaining patients. Adenosine decreased both PAP and systemic arterial pressure significantly, while iloprost inhalation selectively reduced the PAP and increased the oxygen saturation of femoral arterial blood and the pulmonary-to-systemic flow (Qp/Qs) ratio. Compared with adenosine, iloprost caused a more profound decline in the Pp/Ps ratio, PVR and pulmonary-to-systemic vascular resistance ratio, and increase in the Qp/Qs ratio. The acute haemodynamic responses to adenosine and iloprost varied among the patients with CHDs and severe PAH. Different to adenosine, inhaled iloprost exerted selective pulmonary vasodilative effects and was beneficial for pulmonary gas exchange.

The effect of perioperative inhaled iloprost on congenital heart disease with severe pulmonary arterial hypertension

A 47-year-old male patient in whom atrial septal defect (ASD) had been diagnosed 15 years previously was admitted for cardiac catheterization. He had definite cyanotic lips and nail beds and severe pulmonary arterial hypertension (PAH). He had received medical treatment only for the last few years after being diagnosed with Eisenmenger syndrome. After cardiac catheterization, he received iloprost inhalation therapy pre and postoperation and was discharged after successful surgical closure of the ASD.