Department of Cardiovascular Surgery, Osaka Medical College Hospital, Takatsuki, Osaka, Japan.
Eur J Cardiothorac Surg. 2010 Jul;38(1):71-7. doi: 10.1016/j.ejcts.2010.01.045. Epub 2010 Mar 4.
Sildenafil is a strong pulmonary vasodilator that increases the intracellular cyclic guanosine monophosphate concentration through inhibition of phosphodiesterase-5. We assessed the benefit of oral sildenafil for persistent pulmonary hypertension early after congenital cardiac surgery in paediatric patients.
Sildenafil was administered at a starting dose of 0.5 mg kg(-1) following admission to the intensive care unit. With careful monitoring of haemodynamics, the dose was increased stepwise by 0.5 mg kg(-1) every 4-6 h up to a maximum of 2 mg kg(-1). After successful weaning from a ventilator and from other vasodilators, sildenafil was gradually discontinued over the next 5-7 days.
A retrospective review of medical records showed an age distribution of <1 month (n=26), > or = 1-<6 months (n=36), > or = 6-<12 months (n=19), 1-3 years (n=8), 4-9 years (n=9) and >10 years (n=2) at the time of surgery. The surgeries were performed for ventricular septal defect closure (n=17), arterial switch (n=30), truncus arteriosus repair (n=10), complete atrioventricular septal defect repair (n=12), total anomalous venous drainage repair (n=9), and other open-heart surgery (n=22). The aforementioned concomitant inhaled nitrous oxide treatment was performed in 66 patients. Pulmonary arterial pressure decreased in 28, was unchanged in five and elevated in one patient out of the total of 34 cases for which data from continuous pressure monitoring were available. Bosentan was added in three cases with persistent symptoms due to pulmonary hypertension despite sildenafil treatment. After sildenafil administration, modest oxygen desaturation occurred in seven cases, but no 'rebound' pulmonary hypertension occurred. There were no significant adverse events during sildenafil treatment.
Our results suggest that oral sildenafil is a safe and effective alternate for persistent pulmonary hypertension following congenital heart surgery in children.
西地那非是一种强效的肺动脉扩张剂，通过抑制磷酸二酯酶-5 增加细胞内环鸟苷酸浓度。我们评估了口服西地那非对先天性心脏手术后早期持续性肺动脉高压的益处。
患儿入住重症监护病房后，起始剂量为 0.5mg/kg 口服。在密切监测血流动力学的情况下，每 4-6 小时剂量增加 0.5mg/kg，最大剂量为 2mg/kg。成功撤离呼吸机和其他血管扩张剂后，在接下来的 5-7 天内逐渐停用西地那非。
回顾性病历审查显示，手术时患儿年龄分布为<1 个月（n=26）、>或=1-<6 个月（n=36）、>或=6-<12 个月（n=19）、1-3 岁（n=8）、4-9 岁（n=9）和>10 岁（n=2）。手术类型为室间隔缺损修补术（n=17）、大动脉调转术（n=30）、动脉干修复术（n=10）、完全性房室间隔缺损修补术（n=12）、完全性肺静脉异位引流修复术（n=9）和其他心脏直视手术（n=22）。34 例患儿中，28 例肺动脉压下降，5 例无变化，1 例升高。66 例患儿同时吸入一氧化二氮治疗。尽管使用西地那非治疗，但因肺动脉高压持续存在而加用波生坦的患儿有 3 例。西地那非治疗后，7 例患儿出现轻度氧饱和度下降，但无“反弹”性肺动脉高压。西地那非治疗期间无严重不良事件。
我们的结果表明，口服西地那非是先天性心脏病术后儿童持续性肺动脉高压的一种安全有效的替代治疗方法。
