Sildenafil for pulmonary hypertension due to left-toright shunt after corrective procedure
Abstract: Background Pulmonary
arterial hypertension (PAH) is a common complication seen in those with a
left-to-right shunt congenital heart defect (CHD). Corrective procedures by
surgery or catheterization are the therapies of choice for reversible PAH.
Since morbidity and mortality due to PAH after correction is high, sildenafil
has been used as a selective vasodilator of the pulmonary artery, in order to
decrease pulmonary arterial pressure. Objectives To evaluate the effect of
sildenafil on pulmonary arterial pressure and clinical outcomes after
left-to-right shunt CHD corrective procedures. Methods Left-to-right shunt
patients aged < 18 years scheduled for corrective treatment were randomized
in a double-blind fashion, to receive either oral sildenafil or placebo, given
on days 3 to 30 after the corrective procedure. Clinical and pulmonary arterial
pressures were evaluated by echocardiography before, 3 days after, and 30 days
after the corrective procedure. Results From July 2013 to June 2014, 36
patients were included in the study: 17 in the placebo and 19 in the sildenafil
groups. There were no differences in pulmonary arterial pressure or in clinical
outcomes after corrective procedure between the two groups. There were no
adverse events during the treatment. Conclusion Sildenafil has little effect on
decreasing pulmonary arterial pressure, as most of our subjects seem to have
hyperkinetic PAH. As such, pulmonary arterial pressure returns to normal soon
after corrective procedures.
Author: Dyahris Kuntartiwi,
Piprim Basarah Yanuarso, Sudigdo Sastroasmoro
Journal Code: jpkedokterangg150264