Aerosolized iloprost for postoperative pulmonary hypertensive crisis in children with congenital heart disease

Abstract 

Introduction

Pulmonary hypertensive crisis (PHC) is a significant contributor to the morbidity and mortality of surgery for congenital heart defect. Management of such a potentially fatal complication has been evolving for the past decades. Inhaled iloprost has been reported as an alternative treatment for this condition. We evaluated the use of aerosolized iloprost as a rescue therapy for PHC in children undergoing congenital heart surgery.

Methods

In this clinical study, 12 high risk children were monitored in order to identify postoperative PHC after congenital heart repair. Factors being monitored included pulmonary artery pressure, systemic blood pressure, left atrial pressure, transcutaneous oximetry and heart rate. PHC was defined as an acute rise in pulmonary pressure which causes cardiopulmonary compromise as reflected by desaturation and hypotension. Despite conventional medical treatment to prevent postoperative PHC, children with PHC were therefore administered with aerosolized iloprost (0.5 μg/kg).

Result

Eight of the 12 children had one or more episodes of PHC, secondary to the pulmonary vasoreactivity. All responded to the aerosolized iloprost treatment, as demonstrated by a fall in their mean pulmonary pressure from 47.9±14.9 to 30.2±7.9 mmHg (p=0.012) and a rise in the arterial saturation from 82.2±16.7 to 93.4±11.5 % (p=0.012) while mean systemic blood pressure tended to increase from 59.4±12.1 to 64±10.3 mmHg (p=0.16).

Conclusion

In medical setting with limited access to the nitric oxide, inhaled iloprost is consider to be an effective alternative treatment for postoperative PHC in children undergoing congenital heart surgery.

Keywords: Pulmonary hypertensive crisis, congenital heart surgery, Prostacyclin, Aerosolized iloprost, Pulmonary arterial hypertension, Children