OBJECTIVETo observe the acute hemodynamic effects of intravenous diltiazem in patients with congenital heart defect (CHD) and severe pulmonary hypertension (HP) post cardiac surgery.

METHODSFrom November 2003 to September 2005, 12 patients with CHD and severe HP (4 male, mean age 17.8 +/- 9.8 years) after cardiac surgery received intravenous diltiazem (3 - 5 microg x kg(-1) x min(-1)) in the Intensive Care Unit. Mean pulmonary artery pressure (mPAP), mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR) were monitored with Swan-Ganz catheter before (T1) and 6 hours (T2) after diltiazem injection, before weaning patients off of ventilator (T3), 1 hour (T4) and 24 hour (T5) after extubation.

RESULTSAll patients survived during the observation period and no patient developed pulmonary hypertension crisis. The average ventilation time was (88.7 +/- 50.1) hours. Mean ICU stay time was (5.8 +/- 3.1) days. Compared to T1, mPAP was significantly decreased at T3 and T5, MAP significantly increased at T4 and T5, HR significantly reduced at T2 and thereafter, SV significantly increased at T3, T4 and T5 and PVR significantly increased at T3 and T5 while SVR remained unchanged after diltiazem therapy.

CONCLUSIONIntravenous use of diltiazem is safe and effective for patients with CHD with severe HP post cardiac surgery.