Sildenafil therapy for pulmonary hypertension before and after pediatric congenital heart surgery

• Published in: Texas Heart Institute journal Vol. 38; no. 3; pp. 238 - 242
• Main Authors: Palma, Gaetano, Giordano, Raffaele, Russolillo, Veronica, Cioffi, Sabato, Palumbo, Sergio, Mucerino, Marco, Poli, Vincenzo, Vosa, Carlo
• Format: Journal Article
• Language: English
• Published: United States Texas Heart Institute 2011
• Subjects: Administration, Oral; Antihypertensive Agents - administration & dosage; Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Cardiac Surgical Procedures - adverse effects; Cardiopulmonary Bypass; Child, Preschool; Clinical Investigation; Drug Administration Schedule; Female; Heart Defects, Congenital - complications; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Humans; Hypertension, Pulmonary - drug therapy; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Infant; Intensive Care Units; Italy; Length of Stay; Male; Phosphodiesterase 5 Inhibitors - administration & dosage; Phosphodiesterase 5 Inhibitors - therapeutic use; Piperazines - administration & dosage; Piperazines - therapeutic use; Purines - administration & dosage; Purines - therapeutic use; Respiration, Artificial; Retrospective Studies; Sildenafil Citrate; Sulfones - administration & dosage; Sulfones - therapeutic use; Time Factors; Treatment Outcome; Vasodilator Agents - administration & dosage; Vasodilator Agents - therapeutic use; Italy; hemodynamics/drug effects; hypertension, pulmonary/drug therapy/prevention & control; piperazines/therapeutic use; vasodilator agents/therapeutic use; postoperative complications/prevention & control; heart defects, congenital/surgery; 3′,5′-cyclic-GMP phosphodiesterases/antagonists & inhibitors; sildenafil; treatment outcome; antihypertensive agents/therapeutic use
• ISSN: 0730-2347; 1526-6702

Pulmonary hypertension associated with pediatric congenital heart defects is a major cause of postoperative morbidity and death. Sildenafil has been combined with inhaled nitric oxide to treat pulmonary hypertension. We retrospectively studied the pre- and postoperative effects of oral sildenafil as monotherapy in children with pulmonary hypertension who underwent surgery to correct congenital cardiac defects. From September 2005 through November 2009, 38 children with moderate-to-severe pulmonary arterial hypertension (pulmonary arterial/aortic pressure ratio, >0.7) underwent cardiac surgery at our institution. Fifteen patients were given sildenafil (0.35 mg/kg, every 4 hr) orally or through nasogastric tubes 1 week before and 1 week after surgery. Twenty-three patients of comparable medical status were given sildenafil only upon the institution of cardiopulmonary bypass and for 1 week after surgery. Postoperatively, the 15 patients who were given preoperative sildenafil had significantly lower mean pulmonary arterial pressures (25.6 ± 3.1 vs. 30.4 ± 5.7 mmHg; P = 0.005) and pulmonary arterial/aortic pressure ratios (0.35 ± 0.05 vs. 0.42 ± 0.07; P = 0.002) than did the other 23 patients. The preoperative therapy also shortened cardiopulmonary bypass time, mechanical ventilation time, and lengths of intensive care unit and hospital stays. No sildenafil-related hypertensive crises or sequelae occurred. As monotherapy, oral sildenafil in low doses appears to control pulmonary hypertension safely and effectively in children undergoing operations to correct congenital heart defects, particularly when it is given both preoperatively and postoperatively. Further study is warranted.