beraprost and Postoperative-Complications

Therapeutic strategies for pulmonary arterial hypertension (PAH) associated with atrial septal defect (ASD) remain a matter of debate.. We identified 5 outpatients who had been diagnosed with ASD-PAH and undergone ASD closure in combination with targeted therapy with certified PAH drugs. We assessed changes in hemodynamic parameters and exercise capacity. The combination of ASD closure and targeted therapy significantly increased systemic blood flow (Qs) from the baseline (from 3.3 ± 0.6 L/minute to 4.2 ± 1.0 L/minute, P < 0.05) with a significant improvement in the World Health Organization Functional Class (WHO-FC; from 2.8 ± 0.4 to 1.6 ± 0.5, P < 0.05). The hemodynamic data before and after ASD closure without targeted therapy showed further elevation of pulmonary vascular resistance shortly after ASD closure (678 dyne · s/cm(5) to 926 dyne · s/cm(5)) in 1 case, as well as after a long time since ASD closure (491.0 ± 53.7 dyne · s/cm(5) to 1045.0 ± 217.8 dyne · s/cm(5)) in 2 cases. This worsening was reversed after the targeted therapy, accompanied by an increase in Qs and an improvement in WHO-FC in all cases.. Targeted therapy should be added to ASD closure in adult patients with ASD-PAH.

Topics: Adult; Antihypertensive Agents; Atrial Septum; Bosentan; Cardiac Catheterization; Cardiac Surgical Procedures; Disease Management; Epoprostenol; Exercise Tolerance; Female; Heart Septal Defects, Atrial; Hemodynamics; Humans; Hypertension, Pulmonary; Japan; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Sulfonamides; Treatment Outcome; Vascular Resistance; Vasodilator Agents

Two episodes of hypotension caused by oral beraprost sodium administration following cardiac surgery are described. The first case was a 67-year-old female who underwent concomitant surgery for mitral valve replacement, tricuspid annuloplasty, and a radiofrequency maze procedure for atrial fibrillation. The second case was a 45-year-old female who underwent 4-vessel coronary artery bypass grafting associated with endarterectomy in the right coronary artery. Beraprost sodium was administered for the treatment of residual pulmonary hypertension in the first case, and was initiated as an antiplatelet agent following coronary endarterectomy in the second case. Hypotension occurred at approximately one hour after beraprost sodium administration in both cases. Careful observation to prevent this adverse effect is critical after the administration of beraprost sodium, especially in patients who have undergone cardiac surgery.

Topics: Aged; Atrial Fibrillation; Cardiac Surgical Procedures; Catheter Ablation; Coronary Artery Bypass; Coronary Artery Disease; Diabetes Complications; Endarterectomy; Epoprostenol; Female; Heart Valve Prosthesis Implantation; Humans; Hypotension; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Postoperative Complications; Tricuspid Valve Insufficiency; Vasodilator Agents

Topics: Administration, Oral; Adult; Epoprostenol; Humans; Kidney Transplantation; Male; Postoperative Complications; Renal Artery Obstruction; Vasodilator Agents