Iranian Journal of Pediatrics
Tehran University of Medical Sciences Press
Vol. 23, No. 1, 2013, pp. 19-26
Bioline Code: pe13004
Full paper language: English
Document type: Research Article
Document available free of charge
Iranian Journal of Pediatrics, Vol. 23, No. 1, 2013, pp. 19-26
© Copyright 2013 - Iran Journal of Pediatrics
Additive Effect of Phosphodiesterase Inhibitors in Control of Pulmonary Hypertension after Congenital Cardiac Surgery in Children|
Peiravian, Farah; Amirghofran, Ahmad-Ali; Ghamsari, Hanane & Emaminia, Abbas
Objective: Control of residual pulmonary arterial hypertension (PAH) after closure of left to right shunts in
children is still a challenging issue. The purpose of this study was to compare the effect of two
phosphodiesterase inhibitors in pediatric cardiac surgical patients.
Methods: A total of 48 postoperative children were enrolled in the study between 2008 and 2010. Patients
were stratified based upon choice of pulmonary vasodilator into three equal groups (n=16); Milrinone group
received intravenous milrinone (0.75 μ/kg/min), Sildenafil group received oral sildenafil (0.3 mg/kg every 3
hours) and the Combination group received both medications.
Findings: Demographic variables and types of congenital anomalies were not different among the 3 groups.
Patients in the Combination group had higher preoperative pulmonary artery to aortic (PA/AO) pressure
ratios compared to other two groups (P=0.001). Postoperatively, patients in Milrinone group incurred lower
systolic PA and PA/AO pressures compared to Sildenafil group (P=0.014, 0.003), but it was the same in
Sildenafil and Combination group (P=0.2; 0.330 respectively). Pulmonary hypertensive crisis was noted in 6
patients in Sildenafil group, and 3 patients in Combination group (P=0.02). Significant rise in PA pressure was
noticed after discontinuation of drug in Milrinone group (P=0.001), which was not observed in the
Combination group (P= 0.6). No mortality was noticed in any of the groups.
Conclusion: Intravenous milrinone is more effective than oral sildenafil in control of postoperative PAH and
elimination of pulmonary hypertensive crisis. Combination of two drugs reduces the risk of rebound
pulmonary arterial hypertension after discontinuation of milrinone.
Phosphodiesterase Inhibitors; Pulmonary arterial hypertension; Cardiac surgery; Children
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