iloprost and Transposition-of-Great-Vessels

This report describes the case of a neonate with d-transposition of the great arteries and severe pulmonary arterial hypertension stabilised in the post-operative period with continuous iloprost nebulisation. To our knowledge, this is the first documented method of treating post-operative severe pulmonary arterial hypertension with continuous inhaled iloprost in a patient with complex CHD. We found this method of delivering the drug very effective in stabilising haemodynamic swings in the setting of severe pulmonary arterial hypertension.

Topics: Administration, Inhalation; Arteries; Fatal Outcome; Female; Hemodynamics; Humans; Hypertension, Pulmonary; Iloprost; Infant, Newborn; Nitric Oxide; Transposition of Great Vessels; Vasodilator Agents

Transposition of the great arteries (TGA) in the newborn combined with persistent pulmonary hypertension was reported previously to occur in 3-12 % of full-term neonates with TGA. Right-to-left shunting at the ductal level causes severe hypoxemia despite prostaglandin infusion and balloon atrial septostomy. Although the introduction of inhaled nitric oxide (iNO) has improved the prognosis, this condition still is associated with high preoperative mortality. This report describes the case of a newborn with TGA and persistent pulmonary hypertension, which was managed successfully with oral sildenafil, iNO, and inhaled iloprost during life-threatening acute pulmonary hypertension, thus preventing the use of extracorporeal membrane oxygenation.

Topics: Abnormalities, Multiple; Administration, Inhalation; Cardiac Surgical Procedures; Dose-Response Relationship, Drug; Follow-Up Studies; Humans; Iloprost; Infant, Newborn; Male; Persistent Fetal Circulation Syndrome; Pulmonary Wedge Pressure; Transposition of Great Vessels; Vasodilator Agents

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