u-62840 and Postoperative-Complications

Portopulmonary hypertension (PoPH) refers to pulmonary arterial hypertension associated with portal hypertension with or without evidence of an underlying liver disease. Despite the potential for curing PoPH with liver transplantation, the presence of moderate or severe PoPH is associated with increased morbidity and mortality and is, therefore, a contraindication to transplantation. Previous studies have predominantly used intravenous epoprostenol for treatment in order to qualify patients for liver transplantation. In this retrospective case series, we describe the clinical course of 11 patients whom we successfully treated (predominantly with oral sildenafil and subcutaneous treprostinil) in order to qualify them for liver transplantation. The mean pulmonary artery pressure significantly improved from 44 to 32.9 mm Hg, and the pulmonary vascular resistance decreased from 431 to 173 dyn second cm(-5) . There were significant improvements in the cardiac output and the transpulmonary gradient with these therapies as well. All 11 patients subsequently received liver transplants with a 0% mortality rate to date; the duration of follow-up ranged from 7 to 60 months. After transplantation, 7 of the 11 patients (64%) were off all pulmonary vasodilators, and only 2 patients required transiently increased doses of prostacyclins. In conclusion, an aggressive approach to the treatment of PoPH with sildenafil and/or treprostinil and subsequent liver transplantation may be curative for PoPH in some patients.

Topics: Adult; Antihypertensive Agents; Epoprostenol; Female; Follow-Up Studies; Humans; Hypertension, Portal; Length of Stay; Liver Failure; Liver Transplantation; Male; Middle Aged; Phosphodiesterase 5 Inhibitors; Piperazines; Postoperative Complications; Pulmonary Circulation; Purines; Retrospective Studies; Severity of Illness Index; Sildenafil Citrate; Sulfones

Impaired healing of saphenous vein harvest sites is a serious but under-recognized complication of coronary artery bypass grafting surgery, particularly in the presence of peripheral arterial disease. We report the use of a continuous subcutaneous infusion of treprostinil sodium, an analog of prostacyclin, to treat a limb-threatening, nonhealing saphenous vein harvest incision site after myocardial revascularization.

Topics: Aged; Arterial Occlusive Diseases; Coronary Artery Bypass; Coronary Disease; Epoprostenol; Humans; Infusions, Intravenous; Injections, Subcutaneous; Male; Peripheral Vascular Diseases; Postoperative Complications; Risk Assessment; Saphenous Vein; Tissue and Organ Harvesting; Treatment Outcome; Wound Healing; Wounds and Injuries