sildenafil-citrate and Aortic-Valve-Stenosis

Pressure overload resulting from aortic stenosis causes maladaptive ventricular and vascular remodeling that can lead to pulmonary hypertension, heart failure symptoms, and adverse outcomes. Retarding or reversing this maladaptive remodeling and its unfavorable hemodynamic consequences has the potential to improve morbidity and mortality. Preclinical models of pressure overload have shown that phosphodiesterase type 5 inhibition is beneficial; however, the use of phosphodiesterase type 5 inhibitors in patients with aortic stenosis is controversial because of concerns about vasodilation and hypotension.. We evaluated the safety and hemodynamic response of 20 subjects with severe symptomatic aortic stenosis (mean aortic valve area, 0.7 ± 0.2 cm(2); ejection fraction, 60 ± 14%) who received a single oral dose of sildenafil (40 or 80 mg). Compared with baseline, after 60 minutes, sildenafil reduced systemic (-12%; P<0.001) and pulmonary (-29%; P=0.002) vascular resistance, mean pulmonary artery (-25%; P<0.001) and wedge (-17%; P<0.001) pressures, and increased systemic (13%; P<0.001) and pulmonary (45%; P<0.001) vascular compliance and stroke volume index (8%; P=0.01). These changes were not dose dependent. Sildenafil caused a modest decrease in mean systemic arterial pressure (-11%; P<0.001) but was well tolerated with no episodes of symptomatic hypotension.. This study shows for the first time that a single dose of a phosphodiesterase type 5 inhibitor is safe and well tolerated in patients with severe aortic stenosis and is associated with improvements in pulmonary and systemic hemodynamics resulting in biventricular unloading. These findings support the need for longer-term studies to evaluate the role of phosphodiesterase type 5 inhibition as adjunctive medical therapy in patients with aortic stenosis.

Topics: Aged; Aged, 80 and over; Aortic Valve Stenosis; Blood Pressure; Compliance; Cyclic Nucleotide Phosphodiesterases, Type 5; Female; Humans; Male; Phosphodiesterase 5 Inhibitors; Piperazines; Pulmonary Circulation; Purines; Severity of Illness Index; Sildenafil Citrate; Stroke Volume; Sulfones; Treatment Outcome; Ultrasonography; Vascular Resistance; Ventricular Function, Left; Ventricular Function, Right

Topics: Aortic Valve Stenosis; Cyclic Nucleotide Phosphodiesterases, Type 5; Female; Humans; Male; Phosphodiesterase 5 Inhibitors; Piperazines; Pulmonary Circulation; Purines; Sildenafil Citrate; Sulfones

The acute chest syndrome (ACS) of sickle cell disease (SCD) is a leading cause of death in SCD, with a high incidence following surgery, though only one case has been reported following cardiac surgery. We present a case of ACS in an adult undergoing aortic valve replacement (AVR) despite instituting established peri-operative optimization measures to prevent sickling. Early diagnosis of this condition in our patient as a distinct clinical entity facilitated appropriate, specific therapy and a good subsequent postoperative recovery. Greater recognition of this syndrome in the growing number of adult sickle cell patients presenting for cardiac surgery may help improve their outcome.

Topics: Acute Chest Syndrome; Administration, Inhalation; Administration, Oral; Anemia, Sickle Cell; Aortic Valve Stenosis; Combined Modality Therapy; Critical Care; Early Diagnosis; Female; Heart Valve Prosthesis Implantation; Humans; Middle Aged; Nitric Oxide; Piperazines; Purines; Respiration, Artificial; Severity of Illness Index; Sildenafil Citrate; Sulfones; Tomography, X-Ray Computed; Tracheostomy; Treatment Outcome; Vasodilator Agents