Perioperative Combined Use of Sildenafil and Inhaled Iloprost for Moderate Portopulmonary Hypertension in a Patient Undergoing Liver Transplantation: A case report.
10.4097/kjae.2008.54.1.102
- Author:
Duk kyung KIM
1
;
Hae Kyoung KIM
;
Jeong Ae LIM
;
Seung Min JEONG
;
Sung Whwan JANG
;
Ik Jin YUN
Author Information
1. Departments of Anesthesiology and Pain Medicine, and *Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea. dikei@kuh.ac.kr
- Publication Type:Case Report
- Keywords:
iloprost;
liver transplantation;
sildenafil;
pulmonary hypertension
- MeSH:
Arterial Pressure;
Hemodynamics;
Hemorrhage;
Humans;
Hypertension;
Hypertension, Pulmonary;
Iloprost;
Intensive Care Units;
Liver;
Liver Transplantation;
Nebulizers and Vaporizers;
Patients' Rooms;
Piperazines;
Purines;
Sulfones;
Transplants;
Vascular Resistance;
Sildenafil Citrate
- From:Korean Journal of Anesthesiology
2008;54(1):102-108
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Moderate to severe pulmonary hypertension, mean pulmonary arterial pressure (mPAP) > 35 mmHg, in cirrhotic patients is usually considered an absolute contraindication to orthotopic liver transplantation (OLT) because of unacceptably high mortality. We present the case of successful OLT in a cirrhotic patient with a mPAP of 42 mmHg and a pulmonary vascular resistance (PVR) of 298 dyne . sec . cm(-5) preoperatively. He was treated with oral sildenafil (Viagra(R)) and inhaled iloprost (Ventavis(R)) for 45 days and then his mPAP and PVR were reduced to 33 mmHg and 206 dyne . sec . cm(-5) at the time of transplantation. During OLT, his mPAP was stable of 28?38 mmHg with the combined use of sildenafil via a nasogastric tube and iloprost via a nebulizer. His hemodynamic parameters were stable and significant postoperative bleeding was not noticed throughout his stay in the intensive care unit. Thereafter, he was transferred to general ward without any cardio-respiratory problems on 7th postoperative days.
