iloprost and Chronic-Disease

In the pediatric population, pulmonary hypertension may present as an acute event in the setting of lung or cardiac pathology or as a chronic disease, mainly as idiopathic pulmonary hypertension or associated with congenital heart disease. Recently, new pharmacologic approaches have demonstrated significant efficacy in the management of adults with pulmonary arterial hypertension; these include intravenous epoprostenol, prostacyclin analogs, endothelin receptor antagonists and phosphodiesterase type 5 inhibitors. The same treatment strategies are currently used in children. There are only few reports of the use of inhaled iloprost in pediatrics, only one of which reported the use of chronic inhaled iloprost in a significant number of children. This report showed that 1) the acute pulmonary vasodilator response to inhaled iloprost is equivalent to that of inhaled nitric oxide; 2) acute inhalation of iloprost can induce bronchoconstriction 3) the addition of inhaled iloprost can reduce the need for intravenous prostanoid therapy in some patients; 4) most children tolerated the combination of inhaled iloprost and endothelin receptor antagonist or phosphodiesterase inhibitors; 5) Several patients had clinical deterioration during chronic inhaled iloprost therapy and required rescue therapy with intravenous prostanoids. In this review we will discuss the role of inhaled iloprost in acute and chronic pulmonary hypertension in children.

Topics: Acute Disease; Administration, Inhalation; Adult; Antihypertensive Agents; Child; Chronic Disease; Drug Therapy, Combination; Humans; Hypertension, Pulmonary; Iloprost; Treatment Outcome; Vasodilator Agents

Epoprostenol and the structurally related compounds treprostinil, iloprost, and beraprost are collectively referred to as prostanoids. The discovery of epoprostenol in 1976 and unequivocal demonstration of its efficacy in 1996 dramatically altered the approach to therapy for pulmonary arterial hypertension (PAH). Development of prostanoids available through multiple routes of administration and the discovery and development of other agents acting through alternative pathways continue to expand the array of therapeutic options. The use of prostanoids in combination with other PAH drugs and for treating pulmonary hypertensive disorders outside of the PAH classification are areas of ongoing research.

Topics: Antihypertensive Agents; Chronic Disease; Epoprostenol; Heart Defects, Congenital; Humans; Hypertension, Portal; Hypertension, Pulmonary; Iloprost; Prostaglandins; Randomized Controlled Trials as Topic; Respiratory Distress Syndrome

Venous ulceration remains a common problem and a significant challenge to the physicians treating it. Many theories have been advanced in the past to explain its causes but there is little evidence to support tissue hypoxia as the main factor, as was once thought. In recent years attention has focussed on the inflammatory events which attend venous disease and the development of venous ulceration. It has been proposed that these form a major contribution to the development of venous leg ulcers. In the arterial system an analogous series of events appears to cause damage following severe ischemia. Massive neutrophil activation in the microcirculation following reperfusion of a tissue results in severe, ischemic damage to that tissue. A similar series of events is proposed to explain venous disease. During venous hypertension leukocytes are sequestrated in the microcirculation of the lower limb. It has been shown that these undergo activation whilst they are in the leg. The exact location of leukocyte sequestration is unclear but it is suggested that this may occur in the skin. The damage caused to the lower limb skin components can be identified by measuring plasma levels of endothelial adhesion molecules, which are shed into the circulation following a period of venous hypertension. In the long term this leads to a chronic inflammatory state in the skin in some patients where venous hypertension is sustained or there is susceptibility to venous hypertension. The resulting inflammatory process is referred to as "lipodermatosclerosis" and has a number of well known clinical features. There is proliferation of the dermal capillaries eventually leading to a "glomerulus" like appearance. In the skin and subcutaneous tissues there is fibrosis. The microcirculation in the papillary dermis is surrounded by an inflammatory cellular infiltrate. The importance of understanding the mechanisms of the development of venous ulceration is in creating new treatments for this problem. Compression treatment has been effective in healing leg ulcers for thousands of years. Surgical treatment offers a possible cure in patients where superficial venous reflux is the main problem. Deep vein reconstruction is only suitable for a few patients. Many venous ulcers can be healed by compression, only to recur within a few months. Pharmacological treatments may offer the possibility of more rapid ulcer healing and the maintenance of an ulcer-free state if the correct pathophysiological

Topics: Alprostadil; Cell Adhesion Molecules; Chronic Disease; Humans; Iloprost; Leg Ulcer; Leukocytes; Neutrophils; Pentoxifylline; Vasodilator Agents; Venous Insufficiency

Topics: Animals; Arteriosclerosis; Cell Division; Chronic Disease; Disease Models, Animal; Estradiol; Graft Rejection; Heart Transplantation; Iloprost; Male; Muscle, Smooth; Oligopeptides; Peptides, Cyclic; Rabbits; Somatostatin; Transplantation, Homologous

Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are the major classes of pulmonary hypertensive disorders according to the World Health Organization; both lead to right heart failure and death. A better understanding of disease mechanisms has led to the suggestion that the thromboembolic and nonthromboembolic types of pulmonary hypertension may share pathophysiologic features. We therefore compared acute vasoreactivity and proximal pulmonary artery compliance in patients with PAH and CTEPH during the initial diagnostic heart catheterization.. Right heart catheterization using a flow-directed Swan-Ganz catheter was performed in patients with CTEPH (n = 22) and PAH (n = 35). Pulmonary hemodynamics were assessed at baseline, during the inhalation of 40 ppm of nitric oxide, and 30 min after the inhalation of 10 mug of iloprost. To assess the proximal pulmonary artery compliance, the pulse pressure (PP) [systolic-diastolic pressure] and the fractional PP (PPf) [divided by the mean pressure] were calculated.. Both vasodilators produced similar hemodynamic improvement, and the difference between CTEPH and PAH was not significant. The baseline PP and PPf did not vary between the two groups.. Patients with PAH and CTEPH show similar acute vasoreactivity to inhaled nitric oxide and iloprost, and have similar pulmonary artery compliance. These findings support the presence of some shared pathophysiologic pathways in both disorders and may lead to therapeutic implications in patients with inoperable CTEPH.

Topics: Adult; Aged; Aged, 80 and over; Blood Pressure; Bronchodilator Agents; Cardiac Catheterization; Chronic Disease; Compliance; Hemodynamics; Humans; Hypertension, Pulmonary; Iloprost; Lung; Middle Aged; Nitric Oxide; Pulmonary Artery; Pulmonary Embolism; Vasodilation; Vasodilator Agents; World Health Organization

Pulmonary arterial hypertension (PAH), defined as elevated pulmonary arterial pressure and pulmonary vascular resistance, is an end-point of a variety of conditions. The only therapy that has been shown to improve both quality of life and survival is intravenous prostacyclin (prostaglandin I2 (PGI2), epoprostenol). The effect of long-term aerosolized iloprost (Ilomedin, Schering, Berlin, Germany and Vienna, Austria), a stable prostacyclin analogue and potent vasodilator, on haemodynamics and functional status was investigated in 12 patients with severe pulmonary hypertension. Haemodynamic measurements and vasodilator testing by right heart catheterization were performed prior to and after long-term iloprost inhalation therapy. Haemodynamic improvement or increased exercise tolerance was not observed in any of the patients. After a mean+/-SD treatment period of 10+/-5 months, mean+/-SD pulmonary vascular resistance had increased from 11+/-3 Wood Units (mmHg.L(-1).min) to 13+/-4 Wood Units, with unchanged arterial oxygen saturation (92+/-4%, versus 91+/-4%). Within the study period, three patients went into right heart failure and had to be placed on intravenous epoprostenol. The authors conclude that inhaled iloprost in addition to conventional therapy in the presently recommended dose of 100 microg.day(-1) delivered in 8-10 2 h portions, is not an efficient vasodilator therapy in severe pulmonary hypertension. It remains to be shown whether dose increases and/or combination protocols will be effective, or whether inhalation of iloprost may be safe for selected cases of pulmonary hypertension.

Topics: Administration, Inhalation; Adolescent; Adult; Aerosols; Aged; Blood Pressure; Cardiac Output; Chronic Disease; Epoprostenol; Exercise Tolerance; Female; Humans; Hypertension, Pulmonary; Iloprost; Infusions, Intravenous; Male; Middle Aged; Oxygen; Prospective Studies; Pulmonary Circulation; Pulmonary Embolism; Vascular Resistance; Vasodilator Agents

Endothelial vascular tone modulators are thought to be involved in aetiopathogenesis of systemic sclerosis (SS) and of peripheral artery occlusive disease (PAOD). Iloprost, a prostacyclin (PGI2) analogue, induces clinical benefit in patients suffering from peripheral ischaemia. This study was performed to investigate the effect of this drug on endothelial function in vivo to elucidate the role of vascular tone modulators.. Fourteen PAOD and 15 SS patients were treated for 24 and 10 days respectively. On the first day, before and after therapy, nitric oxide metabolites (NO2-/NO3-) and endothelin-1 (ET-1) plasma concentrations were detected; moreover, the endothelium-dependent vasodilatation in response to artificial ischaemia was evaluated by means of an echo-Doppler device.. The echo-Doppler evaluation showed that the percentage of arterial reactive dilatation was not modified by placebo or by iloprost, and that the increase in blood velocity flow lasted for a significant longer time after drug infusion (226.79 +/- 17.49 vs. 310.71 +/- 36.32 s; P > 0.04). NO2-/NO3- and ET-1 plasma concentration were higher in patients than in control subjects (P < 0.004). After 6 h of iloprost infusion, no significant modifications were detected.. This study provides evidence that iloprost enhances the microvascular functional capacity and clinical benefit for patients. The effects of the drug seem to be independently or not directly correlated with its interactions with vascular tone modulators such as NO2-/NO3- or ET-1.

Topics: Adult; Aged; Arterial Occlusive Diseases; Chronic Disease; Endothelin-1; Endothelium, Vascular; Female; Humans; Iloprost; Infusions, Intravenous; Ischemia; Male; Microcirculation; Middle Aged; Nitrates; Nitric Oxide; Nitrites; Scleroderma, Systemic; Ultrasonography; Vasodilator Agents

The traditional medical treatment of atherosclerotic artery disease of the lower limbs with vasodilators, antiplatelet agents, hemorheologic agents and heparin has so far yielded only partly satisfactory results. In view of this, we have treated ten patients with lower limb arterial disease, Fontain stages III and IV, with a stable prostacyclin analogue, iloprost, with antiaggregant, vasodilating, and cytoprotective activity. Patients' mean age 73.6 +/- 9.9 yrs., M/F ratio 9/1. The drug was infused by peristaltic pump at dosages varying from 1.5 to 2 ng/kg body weight/min for 6 hours daily and for an average of 25 days. Our observations, albeit on a limited number of subjects, appear to confirm the good tolerability, and above all the efficacy of iloprost (relative number of patients improved: 0.70). Nevertheless, in our view, a hypertensive diabetic woman who under treatment developed a lower myocardial infarction deserves special attention. Data found in the literature do not allow us to hold iloprost responsible for this effect with any degree of certainty. However, the doubt remains that as a result of its vasodilating action the drug may have caused steal phenomena from the subendocardial to subepicardial districts, thus provoking the ischemic event.

Topics: Aged; Aged, 80 and over; Arteriosclerosis Obliterans; Chronic Disease; Female; Humans; Iloprost; Male; Middle Aged

The effectiveness of iloprost, a prostacyclin derivative, was assessed in a placebo-controlled multicentre trial on 101 patients with chronic arterial disease, stage IV. All patients were on a basic local treatment, 53 randomly being assigned to the iloprost group, 48 to the placebo one. Both groups received identical saline infusions, one with the other without iloprost. Infusions were given on 28 consecutive days, iloprost being added at a dose of up to 2 ng/kg.min over six hours. At the end of the treatment period, 32 of 52 patients (61.5%) of the iloprost group and eight of the 47 in the placebo group (17%) had partial or complete healing of ulcers (P less than 0.05), the treatment effect persisting in both groups for a mean duration of at least one year. Iloprost was well tolerated, once individual dosages had been appropriately adjusted. Facial flushes, headache and nausea were the most common side effects. Heart rate and blood-pressure variations did not differ between the two groups.

Topics: Adult; Aged; Aged, 80 and over; Arterial Occlusive Diseases; Cardiovascular Agents; Chronic Disease; Clinical Trials as Topic; Epoprostenol; Female; Follow-Up Studies; Humans; Iloprost; Male; Middle Aged; Multicenter Studies as Topic; Placebos; Random Allocation; Time Factors

Twelve female patients with severe secondary Raynaud's phenomenon were treated in a randomized order with both placebo and Iloprost infusions. Infusions were for 5 hours on 3 consecutive days and Iloprost was administered at variable dosage from 1.0 to 3.0 ng/kg/min. A 6-week follow-up period was used between the two sets of infusions. A significant number of patients reported Iloprost had improved Raynaud's symptomatology compared with placebo and this effect lasted for up to 6 weeks. The number of attacks of Raynaud's as recorded by patients in diary books was similarly reduced after Iloprost. Digital and nail-bed blood flows measured by laser-Doppler methods were increased for up to 6 weeks after Iloprost, but not after placebo infusions. Iloprost may be a useful therapeutic agent in the treatment of severe secondary Raynaud's syndrome.

Topics: Aged; Body Temperature; Chronic Disease; Clinical Trials as Topic; Dose-Response Relationship, Drug; Epoprostenol; Female; Fingers; Humans; Iloprost; Infusions, Intravenous; Middle Aged; Platelet Aggregation; Random Allocation; Raynaud Disease; Regional Blood Flow; Time Factors

Acute vasoreactivity testing (AVT) which reflects the compliance of the pulmonary vascular bed has been proven to be of prognostic value. The purpose of the present study is to explore the sex differences of hemodynamics during the AVT and their impact on event-free survival in patients with chronic thromboembolic pulmonary hypertension (CTEPH).. Eighty-six patients underwent a right heart catheterization and AVT at Shanghai Pulmonary Hospital from February 2009 to February 2018. Univariate and multiple stepwise regression analysis were performed to determine the predictors of independent event-free survival, and receiver operating characteristic curve was plotted to determine the cut-off value of independent parameters in CTEPH.. There were no significant differences in both demographics and hemodynamics between male and female patients with CTEPH. Except ΔPVR/PVR showed a significantly higher difference in female than male patients (P = 0.034). Male patients had higher mRAP of pre- and post-AVT than female patients in the event-free subgroup, while, female patients showed higher PVR of pre-AVT than male patients in the event subgroup (P < 0.05). The mRAP and SvO. Hemodynamics during the AVT varied between male and female patients with CTEPH. Both sexes displayed unique hemodynamic responses that were independently able to predict event-free survival. Therefore, better estimates of prognosis in CTEPH can be made when sex differences are also taken into consideration.

Topics: Administration, Inhalation; Adult; Aged; Cardiac Catheterization; China; Chronic Disease; Female; Hemodynamics; Humans; Hypertension, Pulmonary; Iloprost; Lung; Male; Middle Aged; Predictive Value of Tests; Prognosis; Progression-Free Survival; Pulmonary Embolism; Pulmonary Wedge Pressure; Regression Analysis; ROC Curve; Sex Characteristics; Vasodilator Agents

Chronic thromboembolic pulmonary hypertension (CTEPH) is a subset of pulmonary hypertension caused by acute and recurrent pulmonary emboli. Pulmonary thromboendarterectomy is the treatment of choice, but 10-50% of patients are ineligible for this procedure. We describe the case of a 25-year-old, morbidly obese (228-kg, body mass index 83.5 kg/m(2) ) pregnant woman (G3 P2 ) who presented at 24 weeks' gestation; bilateral pulmonary angiography revealed filling defects and confirmed the diagnosis of CTEPH. The patient was evaluated and deemed to present too high of a risk for pulmonary thromboendarterectomy, so a multidisciplinary team initiated medical therapy. Sildenafil 20 mg orally 3 times/day was started at week 24 of gestation, and inhaled iloprost was added at 26 weeks and titrated to 5 µg inhaled every 2 hrs in order to optimize hemodynamic status prior to a cesarean section delivery scheduled to be performed 6 weeks later. At 32 weeks of gestation, the patient's pulmonary arterial systolic pressure was 77 mm Hg, right atrial pressure was 15 mm Hg, and pulmonary capillary wedge pressure of 16 mm Hg, and a healthy 1741-g male infant was delivered by cesarean section. The patient was transferred back to the medical intensive care unit in stable condition and discharged home 9 days following the procedure. Pharmacotherapeutic strategies for patients with CTEPH who become pregnant are limited to phosphodiesterase type 5 inhibitors and prostacyclin analog therapies due to the teratogenicity of the other drug classes used to treat the disorder (endothelin receptor antagonists and soluble guanylate cyclase stimulators). To our knowledge, this is the first case report of inhaled iloprost use in addition to oral sildenafil to improve patient symptomatology and hemodynamics during the peripartum period of a young pregnant patient with inoperable CTEPH. This drug therapy was used safely, with no noted adverse effects to the newborn or to the patient.

Topics: Administration, Inhalation; Adult; Chronic Disease; Female; Humans; Hypertension, Pulmonary; Iloprost; Pregnancy; Pregnancy Complications; Pulmonary Embolism

Whether medical therapy alone may reduce the amputation rates in patients with chronic limb ischemia and who are unsuitable for revascularization is a controversial topic. In this study, we aimed to investigate the effects of 1 week infusion of iloprost in the treatment of patients with chronic limb ischemia.. Twenty-seven consecutive patients were included in the study. There were 23 men (85.2%) and 4 women (14.8%) with a mean age of 68.93 ± 14.84 years. Patients were considered eligible if they were unsuitable for surgical and endovascular revascularization. Follow-up was made on 10th day and 6th month and included ankle brachial index and clinical assessment.. Minor side effects occurred in four patients (16.0%), but the treatment was continued. In-hospital mortality occurred in one patient (4.0%). Another two patients died and four patients received amputation until follow-up (overall mortality 11.1%). There was significant increase in mean ankle-brachial index values between 1st day and 10th day (p < 0.001), between 1st day and 6th month (p < 0.001), and between 10th day and 6th month (p < 0.001).. One-week treatment with iloprost may provide both long lasting symptomatic benefit and may improve hemodynamic parameters, which were shown to predict future amputation.

Topics: Adult; Aged; Aged, 80 and over; Amputation, Surgical; Ankle Brachial Index; Chronic Disease; Critical Illness; Drug Administration Schedule; Endovascular Procedures; Female; Hospital Mortality; Humans; Iloprost; Infusions, Intravenous; Ischemia; Lower Extremity; Male; Middle Aged; Prospective Studies; Risk Factors; Time Factors; Treatment Outcome; Vascular Surgical Procedures; Vasodilator Agents

Topics: Adult; Arm Injuries; Biopsy, Needle; Burns; Chronic Disease; Clindamycin; Delayed Diagnosis; Drug Therapy, Combination; Follow-Up Studies; Granuloma; Humans; Iloprost; Immunohistochemistry; Injury Severity Score; Male; Risk Assessment; Severity of Illness Index; Skin Ulcer; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome

There are only a few reports of pulmonary hypertension (PH) in hypersensitivity pneumonitis (HP) and an approved vasomodulatory therapy for PH does not exist at all for interstitial lung disease (ILD), particularly for HP.. The case of a 53-year-old woman with chronic HP and severe life-threatening PH treated with a combined specific vasomodulatory therapy is reported. Sustained clinical and hemodynamic improvement was achieved.. Further investigation of PH in HP and specific vasomodulatory therapy is necessary.

Topics: Alveolitis, Extrinsic Allergic; Chronic Disease; Drug Therapy, Combination; Female; Humans; Hypertension, Pulmonary; Iloprost; Middle Aged; Phenylpropionates; Piperazines; Purines; Pyridazines; Sildenafil Citrate; Sulfones; Vasodilator Agents

Cyclooxygenase-2 (COX-2) is upregulated in pulmonary artery smooth muscle cells (PASMCs) during hypoxia and may play a protective role in the response of the lung to hypoxia. Selective COX-2 inhibition may have detrimental pulmonary vascular consequences during hypoxia.. To investigate the role of COX-2 in the pulmonary vascular response to hypoxia, we subjected wild-type and COX-2-deficient mice to a model of chronic normobaric hypoxia. COX-2-null mice developed severe pulmonary hypertension with exaggerated elevation of right ventricular systolic pressure, significant right ventricular hypertrophy, and striking vascular remodeling after hypoxia. Pulmonary vascular remodeling in COX-2-deficient mice was characterized by PASMC hypertrophy but not increased proliferation. Furthermore, COX-2-deficient mice had significant upregulation of the endothelin-1 receptor (ET(A)) in the lung after hypoxia. Similarly, selective pharmacological inhibition of COX-2 in wild-type mice exacerbated hypoxia-induced pulmonary hypertension and resulted in PASMC hypertrophy and increased ET(A) receptor expression in pulmonary arterioles. The absence of COX-2 in vascular smooth muscle cells during hypoxia in vitro augmented traction forces and enhanced contractility of an extracellular matrix. Treatment of COX-2-deficient PASMCs with iloprost, a prostaglandin I(2) analog, and prostaglandin E(2) abrogated the potent contractile response to hypoxia and restored the wild-type phenotype.. Our findings reveal that hypoxia-induced pulmonary hypertension and vascular remodeling are exacerbated in the absence of COX-2 with enhanced ET(A) receptor expression and increased PASMC hypertrophy. COX-2-deficient PASMCs have a maladaptive response to hypoxia manifested by exaggerated contractility, which may be rescued by either COX-2-derived prostaglandin I(2) or prostaglandin E(2).

Topics: Animals; Blood Pressure; Cells, Cultured; Chronic Disease; Collagen; Cyclooxygenase 2; Dinoprostone; Endothelin-1; Gels; Hypertension, Pulmonary; Hypertrophy, Right Ventricular; Hypoxia; Iloprost; Mice; Mice, Mutant Strains; Muscle Contraction; Muscle, Smooth, Vascular; Pulmonary Artery; Receptor, Endothelin A; Traction; Vasoconstriction; Vasodilator Agents

Topics: Aged; Chronic Disease; Dose-Response Relationship, Drug; Endarterectomy; Humans; Hypertension, Pulmonary; Iloprost; Male; Platelet Aggregation Inhibitors; Prostaglandins; Pulmonary Embolism

Chronic thromboembolic pulmonary hypertension (CTPH) is an uncommon complication of pulmonary embolism. The treatment of choice is thromboendarterectomy, a safe and effective surgical procedure in expert hands. However, a fair number of patients are not considered candidates for thromboendarterectomy or do not accept the risk involved. Such patients may respond well to prostacyclin or its derivatives. In recent years new vasodilator drugs administered by a variety of routes have appeared on the market. These drugs have been studied mainly for their effects on primary pulmonary hypertension or hypertension associated with connective-tissue diseases. Few trials have assessed their efficacy in patients with CTPH, however. We report 2 cases of CTPH in which thromboendarterectomy was rejected. Neither of the patients responded to the conventional treatment of anticoagulants, diuretics, calcium antagonists, and angiotensin-converting enzyme inhibitors, but they did respond very well clinically, hemodynamically, and functionally to an inhaled prostacyclin analog, iloprost. We discuss the effects of iloprost in patients with CTPH, its mechanism of action, and its use as a potential pharmacological alternative to thromboendarterectomy. We also discuss new pulmonary vasodilators in general.

Topics: Aged; Chronic Disease; Female; Humans; Hypertension, Pulmonary; Iloprost; Male; Pulmonary Embolism; Vasodilator Agents

In primary pulmonary hypertension, aerosolized prostanoids selectively reduce pulmonary vascular resistance and improve right ventricular function. In this study, hemodynamic effects of inhaled iloprost, a stable prostacyclin analogue, were evaluated in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and early after pulmonary thromboendarterctomy (PTE).. Ten patients (mean age 49 years old [32 to 70 years old], New York Heart Association functional class III and IV) received a dose of 33 micro g aerosolized iloprost immediately before surgery (T1), after intensive care unit admission (T2), and 12-hours postoperatively (T3). Effects on pulmonary and systemic hemodynamics and gas exchange were recorded and compared with preinhalation baseline values.. Preoperatively, inhaled iloprost did not significantly change mean pulmonary artery pressure (mPAP), cardiac index (CI), or pulmonary vascular resistance (PVR). Postoperatively, inhaled iloprost induced a significant reduction of mPAP and PVR and a significant increase of CI at T2 and T3. Preinhalation versus postinhalation PVR was as follows: at T1, 847 versus 729 dynes. s. cm(-5), p = 0.45; at T2, 502 versus 316 dynes. s. cm(-5), p = 0.008; and at T3, 299 versus 227 dynes. s. cm(-5), p = 0.004.. In patients with CTEPH, inhalation of iloprost elicits no significant pulmonary vasodilation before surgery, and may have detrimental effects on systemic hemodynamics. Postoperatively, it significantly reduces mPAP and PVR, and enhances CI. Following PTE, inhalation of iloprost is useful to improve early postoperative hemodynamics.

Topics: Administration, Inhalation; Adult; Aged; Chronic Disease; Endarterectomy; Female; Humans; Hypertension, Pulmonary; Iloprost; Male; Middle Aged; Postoperative Period; Preoperative Care; Pulmonary Embolism; Vasodilator Agents

A 40-year-old man had chronic ischaemia of his replanted thumb. Angiography revealed occlusion of both digital arteries and weak collaterals. He was treated for 4 weeks with Iloprost which produced a definite and sustained improvement. As the digital arteries remained occluded, the beneficial effect of Iloprost was attributed to increased flow in the microcirculation and collaterals.

Topics: Adult; Amputation, Traumatic; Chronic Disease; Humans; Iloprost; Ischemia; Male; Replantation; Thumb; Vasodilator Agents

Significant pulmonary hypertension is a predictor of postoperative right heart insufficiency and increased mortality in patients undergoing orthotopic heart transplantation. Since the use of iv vasodilators is limited by their systemic effects, we evaluated the pulmonary and systemic hemodynamic effects of inhaled aerosolized iloprost (IP) in heart transplant candidates with elevated pulmonary vascular resistance (PVR).. Twenty-nine male heart transplant candidates because of dilated or ischemic cardiomyopathy with elevated PVR were included in the study. After assessing baseline hemodynamics, 50 micro g aerosolized IP were administered by inhalation.. Inhalation of iloprost reduced PVR index (PVRI; 416 +/- 180 vs 349 +/- 173 dyn x sec(-1) x m(-2) x cm(-5); P < 0.01) and mean pulmonary artery pressure (MPAP; 28.6 +/- 9 vs 24.2 +/- 9.1 mmHg; P < 0.01), but did not affect blood pressure or systemic vascular resistance. An additional improvement of ventricular performance with an increase of cardiac index (CI; 2.8 +/- 0.7 vs 2.6 +/- 0.7 L x min(-1) x m(-2); P < 0.05) and a decrease of pulmonary capillary wedge pressure (PCWP; 15.6 +/- 6.8 vs 12.8 +/- 7.1 mmHg; P < 0.01) was observed after inhalation of IP.. Inhaled aerosolized iloprost effectively reduces MPAP and is accompanied by an increase in CI and stroke index. Further advantages of iloprost inhalation are the lack of adverse reactions and ease of administration. Iloprost may be a useful drug to screen for vascular reactivity in cardiac transplantation patients.

Topics: Administration, Inhalation; Adult; Aerosols; Aged; Chronic Disease; Heart Failure; Heart Transplantation; Hemodynamics; Humans; Hypertension, Pulmonary; Iloprost; Male; Middle Aged; Nitric Oxide

The treatment of chronic pulmonary hypertension with prostacyclin in children is prone to severe complications due to mandatory long-term venous therapy. Inhaled iloprost has been evaluated in adult patients with good preliminary results.. We report our experience of the use of aerosolized iloprost in an infant treated for pulmonary hypertension associated to a right ventricular failure, which occurred after a neonatal arterial switch operation for transposition of the great arteries. For nine months, hemodynamic and functional status improved and the quality of life was satisfactory at home.. If further experiences and studies support this observation, aerosolized iloprost could be an alternative to prostacyclin venous therapy in treating children with chronic pulmonary hypertension.

Topics: Administration, Inhalation; Cardiovascular Surgical Procedures; Chronic Disease; Humans; Hypertension, Pulmonary; Iloprost; Infant, Newborn; Male; Transposition of Great Vessels; Vasodilator Agents

The resolution of cerebral vasospasm and protection of endothelial damage by Iloprost was evaluated with multicisternal injections. Sixteen adult mongrel dogs (18-20 kg) were assigned to one of three experimental groups. All animals received a total amount of 15 ml fresh unheparinized arterial blood via three injections into the cisterna magna. Selective vertebral angiography was performed on day 0 and subsequently blood injections were performed on the 2nd and 3rd days after the first injection. On the 7th day angiography was reperformed to determine the chronic vasospasm. The first group (5 dogs) was the control group and received intrathecal saline which was equal to the amount of saline in which Iloprost was diluted. The second group (5 dogs) did not receive any treatment until the 7th day. The third group (6 dogs) received Iloprost intrathecally (total 10 micrograms kg-1). In the first two groups angiographic vasospasm was prominent. For the second group intraarterial Iloprost was given on the 7th day in order to evaluate its acute effect. However there was no evidence of resolution of vasospasm. In the third group, resolution of vasospasm was verified on angiograms. Electron microscope studies of basilar arteries of the first two groups revealed degenerative changes of the endothelial cells which were separated from each other and the elastic lamina was irregularly arranged. In the intrathecal Iloprost-treated group there was little thickening in the elastic lamina and the endothelial cells were almost normal in structure. These results can be considered as the evidence of the prophylactic effect of Iloprost given by the intrathecal route in the prevention of chronic cerebral vasospasm.

Topics: Animals; Chronic Disease; Dogs; Endothelium, Vascular; Female; Iloprost; Male; Microscopy, Electron; Platelet Aggregation Inhibitors; Radiography; Random Allocation; Vasodilator Agents; Vertebrobasilar Insufficiency

To examine whether elevated intravascular pressure in chronic hypertension alters responses of vascular smooth muscle to agents of endothelial origin.. Coarctation hypertensive, sham normotensive control, and one-kidney, one clip hypertensive (1K1C) rats were used. Tail systolic, carotid and femoral arterial pressures were measured. Responses to histamine, endothelin-1 and the prostacyclin analog iloprost were evaluated in isolated helically cut strips of thoracic and abdominal aortas, with and without endothelium, from all groups. Responses to nitroglycerin were also evaluated in strips of abdominal aortas.. Thoracic aortas from 1K1C and coarctation hypertensive rats, as well as abdominal aortas from 1K1C rats, but not abdominal aortas from coarctation hypertensive rats were exposed chronically to elevated arterial pressure. Endothelium-dependent maximal relaxation by histamine was significantly depressed in thoracic aortas from both groups of rats, as well as in abdominal aortas from 1K1C rats. Maximal relaxation and sensitivity to histamine were normal in abdominal aortas from coarctation hypertensive rats. Sensitivity to nitroglycerin was impaired in abdominal aortas from 1K1C rats but not in those from coarctation hypertensive rats; maximal relaxation to nitroglycerin was similar in all groups. Relaxation to iloprost was independent of the endothelium, observed only in thoracic aortas and impaired in hypertensive rats. Responses to endothelin-1 were similar in the groups.. Vasorelaxation by histamine, iloprost and nitroglycerin are impaired in hypertension. The impaired relaxation by histamine results from exposure of the vascular endothelium to chronically elevated pressure. This impairment may be related to effects of high pressure in reducing the ability of the endothelium to produce endothelium-derived relaxing factor and inhibit cyclic GMP-dilator mechanisms.

Topics: Acetylcholine; Animals; Aorta, Abdominal; Aorta, Thoracic; Aortic Coarctation; Autacoids; Chronic Disease; Dose-Response Relationship, Drug; Endothelins; Endothelium, Vascular; Histamine; Hypertension; Iloprost; In Vitro Techniques; Male; Muscle, Smooth, Vascular; Nitroglycerin; Rats; Rats, Sprague-Dawley

1. Experimental chronic cerebral vasospasm induced by subarachnoid haemorrhage (SAH) in rabbits was studied in order to evaluate the efficacy of repeated i.v. infusion of Iloprost (ILO). 2. The mean diameter of the basilar artery of intact animals was calculated as 737.5 +/- 52.8 microns while this value was reduced to 237.5 +/- 22.96 microns after SAH. 3. In the ILO treated group the mean diameter of the basilar artery was significantly increased and found to be 593.75 +/- 64.0 microns. 4. No change was observed in intracranial pressure (ICP) except a slight decrease in mean arterial pressure when relatively higher doses of ILO were used. 5. These results were taken as evidence of the high therapeutic value and low side effects of ILO in the treatment of persisting cerebral vasospasm due to SAH.

Topics: Animals; Calcium Channels; Chronic Disease; Iloprost; Ischemic Attack, Transient; Rabbits; Random Allocation; Subarachnoid Hemorrhage

Topics: Arterial Occlusive Diseases; Chronic Disease; Gangrene; Humans; Iloprost; Infusions, Intra-Arterial; Leg; Male; Middle Aged