Sildenafil Use For Treatment Of Pulmonary Hypertensive Crisis After Congenital Heart Surgery

Sildenafil, a phosphodiesterase inhibitor, decreases pulmonary arterial pressure by providing vasodilation in the pulmonary vascular bed. In this study, the effect of sildenafil use was investigated for prevention of pulmonary hypertensive crisis attacks in the postoperative period in patients with congenital heart defects. In our clinic, 9 patients with pulmonary hypertension and congenital heart defects were operated in between November 2005 and May 2006. Mean age of the patients were 9.6±8.1 (3-12) months and the mean body weights were 5.5±0.9 (4-7) kg. All patients were operated following median sternotomy by using extracorporeal circulation after aortic and bicaval cannulation. Medium hypothermia with cold blood cardioplegia was used. Sildenafil treatment was started in the early postoperative period by 0.5 mg/kg/day through the nasogastric tube. The dose was gradually increased up to 2 mg/kg/day and the treatment was maintained for one week. The results of the patients were evaluated retrospectively. Mean pulmonary arterial pressure in the preoperative period was 52.7±7.9 mmHg. Mean intubation times of the patients were 58.4±34.0 (20-100) hours, whereas intensive care unit stay and hospitalization periods were 2-7 (mean 4.8±2.0) and 6-12 (mean 10.11±2.8) days, respectively. During the study, neither mortality, nor important hypotension caused by sildenafil, was detected. Only a pulmonary hypertensive crisis attack was detected in 1 patient. One patient had consistent heart block and permanent pacemaker was implanted. Sildenafil is an effective choice of treatment for prevention of postoperative pulmonary hypertensive crisis in patients with congenital heart defects accompanied by pulmonary hypertension.