(Circulation. 1999;99:1858-1865.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Long-Term Prostacyclin for Pulmonary Hypertension With Associated Congenital Heart Defects
Presented at the 1998 ALA/ALS International Conference, Chicago, Ill, April 28, 1998.
From the Division of Pediatric Cardiology, Columbia Presbyterian Medical Center, New York, NY.
Correspondence to Erika Berman Rosenzweig, MD, Columbia Presbyterian Medical, Center, Division of Pediatric Cardiology, 3959 Broadway, Babies Hospital 2-North, New York, NY 10032-3784. E-mail esb14{at}columbia.edu
Background—Although long-term prostacyclin (PGI2) has been shown to improve hemodynamics, quality of life, and survival in patients with primary pulmonary hypertension, its use in patients with pulmonary hypertension (PHT) and associated congenital heart defects (CHD) has not been evaluated.
Methods and Results—Twenty patients (15±14 years) with PHT and associated CHD (9 atrial septal defect, 7 ventricular septal defect, 4 transposition of the great vessels, 3 patient ductus arteriosus, 3 partial anomalous pulmonary venous return, and 1 aortopulmonary window) who failed conventional therapy (including digitalis; diuretics; oxygen; warfarin; calcium channel blockade, if indicated; and surgery, if operable) were treated with chronic PGI2. Eleven patients had previous cardiac surgery at a median age of 3 years (range, 5 days to 47 years). Eleven of 20 patients had residual systemic to pulmonary shunts. Hemodynamics, NYHA functional class, and exercise capacity were measured at baseline and after 1 year of PGI2 therapy. None of the patients acutely responded to PGI2 administration. Despite lack of an acute response, mean pulmonary artery pressure decreased 21% on chronic PGI2: 77±20 to 61±15 mm Hg (P<0.01, n=16). Cardiac index and pulmonary vascular resistance also improved on long-term PGI2: 3.5±2.0 to 5.9±2.7 L · min-1 · m-2 (P<0.01, n=16), and 25±13 to 12±7 U · m2 (P<0.01, n=16), respectively. NYHA functional class improved from 3.2±0.7 to 2.0±0.9 (P<0.0001, n=19). Exercise capacity increased from 408±149 to 460±99 m (P=0.13, n=14) on long-term PGI2.
Conclusions—Chronic PGI2 improves hemodynamics and quality of life in patients with PHT and associated CHD who fail conventional therapy. As previously demonstrated in patients with primary pulmonary hypertension, long-term PGI2 may have an important role in the treatment of patients with PHT and associated CHD.
Key Words: hypertension, pulmonary • heart defects, congenital • prostacyclin
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