Abstract 2443: Use of Iloprost on the Pulmonary Vascular Reactivity in Pediatric Patients with Pulmonary Hypertension Secondary to Congenital Heart Disease
Background: Knowledge of the pulmonary vasoreactivity to pharmacologic challenge during acute hemodynamic studies in patients with pulmonary artery hypertension secondary to congenital left-to-right shunts will help in the management and prevention of potential life-threatening pulmonary hypertensive crisis and right heart failure.
Objective: It is the aim of this study to establish the efficacy and safety of inhalational or aerosolized prostacyclin analog (iloprost) in this subgroup of patients.
Methods and Results: A prospective, randomized placebo-controlled interventional study was done on 27 pediatric patients ages 1–19 years old with congenital heart disease who underwent cardiac catheterization . Patients were randomly assigned to receive either placebo or aerosolized iloprost 25 ng/k/min for 10 minutes(N=12). Baseline and post-inhalational hemodynamic parameters were determined for both groups. Aerosolized iloprost caused a decline in the mean pulmonary artery pressure by 7.8 ± 1.4 mmHg ( p<0.001 vs. baseline) and in the diastolic PA pressure by 5.33 ± 2.19 mmHg (p<0.001) Patients who received iloprost had a decreased in the pulmonary vascular resistance by 4.21 ± 7.84 woods unit (25% from the baseline) and Rp:Rs ratio declined by 0.19 ± 0.21 (p=0.01 vs. baseline) There was a significant effect in the mean and diastolic PA pressure (p<0.001) as compared to placebo. With inhalational iloprost, there was no systemic arterial hypotension noted and there was no significant change in the cardiac output (−0.12 ± 0.67 L/min; p =0.54 when tested against baseline)
Conclusion: Inhaled iloprost exerted a selective pulmonary hemodynamic response, reducing the mean and diastolic pulmonary artery pressure 30 minutes after inhalation. Moreover, it decreased the pulmonary vascular resistance without significant systemic vasodilation. There were no adverse reaction to iloprost observed.