| BackgroundPulmonary arterial hypertension has become one of the most serious complications after the operation in children with congenital heart defects not only because of the cardiac malformation but also because of the cardiopulmonary bypass. These patients have got many pulmonary complications and sometimes need reintubation, which burdens the patients'families and the whole society. Even though plenty of traditional therapies have been given, we are still looking forward to an effective new drug. Aerosolized iloprost, a stable analogue of prostacyclin, causes selective pulmonary vessels dilation and improves the hemodynamic and outcome in adult severe PAH and now is recommended as a routine therapy. However, in perioperative infants with complicated congenital heart defects, ventilation, inhalation NO, painkillers and tranquilizers are used regularly. we know little about the function of iloprost in this situation.ObjectiveTo investigate the hemodynamic and inspiratory function of aerosolized iloprost in children with pulmonary hypertension (PAH) after complicated congenital heart surgery. Also to observe the outcome of the patients after iloprost therapy.Methods From April 2008 to April 2009, all postoperated children with PAH in ICU, Fuwai hospital were regularly given ventilation and NO 10ppm inhalation for 2 hours since they had come back from OR, and then they were evaluated the systolic pulmonary arterial pressure (sPAP=4×TiVmax2+RAP) with ultrasonic cardiograph. Thirty children, with the average age of (20.41±18.07)month, weight of (8.61±3.29)kg and CPB time of (199.02±71.85)min, PMAP of (35.90±12.46)mmHg, were diagnosed as postoperative PAH because of sPAP/sBP≥0.5.They were divided into two groups (group T and group C) randomly, with ventilation and NO inhalation continuously, and were respectively given inhaled iloprost 100ng.kg-1.min-1*10min and inhaled 0.9%NaCl 4ml, once every 4 hours, for 48hr. We used the 24h cardiac monitors and ultrasonic cardiograph for hemodynamic monitoring in the patients of two groups at the six time points:baseline (t1),20min later after the first inhalation (t2),120min later after the first inhalation (t3),24h later after the treatment (t4),48h later after the treatment (t5),24h after ceasing the last inhalation (t6). We observed the blood coagulating, the liver and kidney function of these patients at t6. The pulmonary complications and special treatments to these patients were also investigated.ResultsAt t1, there was no difference between the two groups in the sPAP and sPAP/sBP. At t2, the sPAP(42.78±11.72)mmHg and sPAP/sBP(0.48±0.13) in group T were both lower than the sPAP(53.13±13.60)mmHg and sPAP/sBP(0.60±0.15) in group C(P<0.05). At t3, the sPAP/sBP of group T was also lower than that of group C,(0.48±0.09) vs (0.59±0.14),(P<0.05). At t4 and t5, the sPAP in group T were (39.84±12.87) and (34.99±12.98)mmHg, with sPAP/sBP (0.42±0.15) and (0.36±0.14), were much lower than those in group C(P<0.01). HR, sBP and RAP showed no notable difference between two groups at every time point. So did the PIP, PaO2 and OI.There were no differences in coagulation, liver and kidney function at t6 between the two groups. One patient showed flush during the treatment in group T and recovered spontaneously after the inhalation. Nevertheless, none in group C.Two patients died from pulmonary hypertension crisis(PAH) in group C and no one in group T.ConclusionInhaled iloprost significantly improves pulmonary hemodynamics in 20min in children with PAH after congenital heart operation. The therapy effects continue 120min and the PAP shows notable decrease when iloprost is being used continually. However, sBP, HR and RAP keep unaffected after iloprost inhalation. So do the PIP, PaO2 and OI. Aerosolized iloprost might improve the survival decreasing the occurrence of PHC. No significant side effects can be found during and after the iloprost using. But we still need the long and large scale investigation to clarify that iloprost could cut down the duration of ventilating, ICU and hospital staying. BackgroundPulmonary arterial hypertension has become one of the most serious complications after the operation in children with congenital heart defects not only because of the cardiac malformation but also because of the cardiopulmonary bypass. These patients have got many complications and often need reintubation, which burdens the patients' families and the whole society. Even though plenty of traditional therapies have been given, we are still looking forward to an effective new drug. Aerosolized iloprost, a stable analogue of prostacyclin, causes selective pulmonary vessels dilation and improves the hemodynamic and outcome in adult severe PAH and now is recommended as a routine therapy. A lot of investigations have been done to estimate the mechanism of iloprost in these patients. However, in postoperated children with congenital heart defects, ventilation, inhalation NO, painkillers and tranquilizers are used regularly. we know little about the acute hemodynamics and mechanism of iloprost in this circumstances.ObjectiveTo investigate the elementary mechanism of inhaled iloprost on pediatrics pulmonary hypertension after congenital heart operation.MethodsFrom April 2008 to April 2009, all postoperated children with PAH in ICU, Fuwai hospital were regularly given ventilation and NO 10ppm inhalation for 2 hours since they had come back from OR, and then we used ultrasonic cardiograph to evaluate the systolic pulmonary arterial pressure (sPAP=4×TiVmax2+RAP). Thirty children, with the average age of (20.41±18.07)month, weight of (8.61±3.29)kg and CPB time of (199.02±71.85)min, PMAP of (35.90±12.46)mmHg, were diagnosed as postoperative PAH because of sPAP/sBP≥0.5.They were divided into two groups (group T and group C) randomly, with ventilation and NO inhalation continuously, and were respectively given inhaled iloprost 100ng.kg-1.min-1*10min and inhaled 0.9%NaCl 4ml, once every 4 hours, for 48hr. We tested the serum cAMP and cGMP of two groups while we were observing the systolic pulmonary pressure and the systolic pulmonary pressure/systolic blood pressure at baseline (t1) and 20min later after the first inhalation (t2), and then compared the difference between two groups.ResultsAt t1, the serum cAMP are (406.64±179.18)pg/dl in group T and (376.01±106.97)pg/dl in group C, without any difference(P>0.05). At t2, with the drops of sPAP and sPAP/sBP, the serum cAMP in group T showed a sharp increase to (578.68±193.05)pg/dl and was definitely higher than that at t1 (P<0.01), although the cAMP was still (406.18±114.43)pg/dl in group C at t2 (P<0.01). At t1, the serum cGMP were (633.24±425.55)pg/dl in group T and (608.48±207.87)pg/dl in group C. At t2, those were (636.64±434.26)pg/dl in group T and (602.84±241.70)pg/dl in group C. There were no any difference between two groups at both t1 and t2(P>0.05), and neither was there between at t1 and t2 in two groups(P>0.05).ConclusionInhaled iloprost significantly decreases the sPAP and sPAP/sBP in 20min in children with PAH after congenital heart operation. The improvement in pulmonary hemodynamics seems to be related with the increase of serum cAMP, and has nothing to do with the serum cGMP.
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