Inhaled Iloprost,NO For The Treatment Of Pulmonary Hypertension After Mitral Valve Replacement

Objective The objective of this study was to compare the relative effects of inhaled iloprost and nitric oxide (iNO) on pulmonary and systemic hemodynamic responses in patients with pulmonary hypertension (PH) after Mitral Valve Replacing Surgery(MVR).Methods From June 2010 to April 2011,33 consecutive patien ts with pulmonary hypertension(PH) who underwent mitral valve rep lacement (MVR)and had received a Swan-Ganz pulmonary artery ca theter were randomly divided into three groups, the control group(n =11), the NO group(n=11)and the IP group (n=11). when all patient s were hemodynamic stability, the control group received convention al treatment, while the NO group received continuous inhaled NO (the concentration of 20ppm)one hour, and the IP group inhaled ilo prost (10ug, lml) 4～5 minutes, the cardiopulmonary hemodynamic indexes and blood gas were recorded before and after the administr ation of Inhaled iloprost and nitric oxide (iNO). including heart rate (HR),mean arterial pressure (mSAP), mean pulmonary arterial pre ssure (mPAP)central venous pressure (CVP), pulmonary capillary we dge pressure (PCWP), cardiac output (CO), systemic vascular resista nce (SVR), pulmonary vascular resistance (PVR) and mixed venous oxygen saturation (SvO2), those indexes were measured and compa red to clear that the feasibility and effectiveness after the replaceme nt of pulmonary hypertension. Beside, the role and effectiveness of both a preliminary comparison, furthermore, the use of cardiovascul ar drugs,the extubation time and the chest blood drainage within 12 hours after the operations were compared between the three groups.Results (1) There were no severe complications and deaths in the three groups. (2) Both NO group and the IP group caused significant decreased in mPAP, PVR, and CVP,as well as significant increases in SvO2 (p<0.05). (3) Compared with inhaled NO, aerosolized iloprost was more effective in reducing mPAP, PVR, CVP. Furthemore, aerosolized iloprost also caused a significant increase of CO and decrease of PCWP when compared with NO (p< 0.05). (4) There was no significant difference in HR, mSAP and SVR after inhaled iloprost and NO (p> 0.05). (5) The extubation time and the chest blood drainage after the operation were all had no significant differences with the three groups (p> 0.05).Conclusions pulmonary hypertension after weaning from CPB was significantly reduced by the selective pulmonary vasodilators inhaled NO and iloprost. However, in a direct comparison of the two substances, iloprost was found to be significantly more effective.