Abstract:BackgroundPulmonary hypertension is a usual complication of long-standing mitral valve disease. Perioperative pulmonary hypertension is a risk factor for right ventricular failure and is an important cause of morbidity and mortality in patients with pulmonary hypertension undergoing mitral valve surgery. Phosphodiesterase-5 inhibitors particularly sildenafil citrate have proven clinical benefit for pulmonary arterial hypertension but have shown discordant results in group 2 pulmonary hypertension patients. We … Show more
“…Left heart failure, an impairment of cardiac function caused by multiple underlying heart diseases, can give rise to changes in myocardial structure and function [ 8 ], and it will progress until left heart pumping dysfunction, decreased filling capacity, and systolic dysfunction occur [ 9 ]. As the course is extended, left heart failure can induce water-sodium retention, congestion in the pulmonary and systemic circulation, elevated left ventricular preload and afterload, and even secondary pulmonary arterial hypertension [ 10 ].…”
Background
To explore the efficacy of beraprost sodium combined with sildenafil and its effects on the vascular endothelial function and inflammation in left heart failure patients complicated with pulmonary arterial hypertension.
Material/Methods
A total of 80 patients with left heart failure complicated with pulmonary arterial hypertension was enrolled as the subjects of this study and assigned into an observation group (n=40) and a control group (n=40) using a random number table. The changes in pulmonary arterial hypertension-associated indicators at 3 months after treatment and the alterations in the levels of cardiac function-associated biochemical indicator brain natriuretic peptide (BNP), inflammatory factor tumor necrosis factor alpha (TNF-α), and mean pulmonary arterial pressure during treatment were compared between the 2 groups.
Results
At 3 months after treatment, the pulmonary arterial hypertension-associated indicators human urotensin II and calcitonin gene-related peptide in the observation group were lower and higher, respectively, than those in control group. Moreover, the observation group had significantly lower BNP and TNF-α levels and mean pulmonary arterial pressure than the control group. After intervention, the echocardiographic parameters left ventricular ejection fraction (LVEF), cardiac output (CO), and stroke volume (SV) in both groups were significantly higher than those before intervention, and the observation group had significantly higher LVEF, SV, and CO than the control group after intervention.
Conclusions
Beraprost sodium combined with sildenafil for left heart failure complicated with pulmonary arterial hypertension can effectively improve pulmonary arterial hypertension, alleviate left heart failure, and reduce inflammatory responses, thereby achieving better clinical efficacy in patients.
“…Left heart failure, an impairment of cardiac function caused by multiple underlying heart diseases, can give rise to changes in myocardial structure and function [ 8 ], and it will progress until left heart pumping dysfunction, decreased filling capacity, and systolic dysfunction occur [ 9 ]. As the course is extended, left heart failure can induce water-sodium retention, congestion in the pulmonary and systemic circulation, elevated left ventricular preload and afterload, and even secondary pulmonary arterial hypertension [ 10 ].…”
Background
To explore the efficacy of beraprost sodium combined with sildenafil and its effects on the vascular endothelial function and inflammation in left heart failure patients complicated with pulmonary arterial hypertension.
Material/Methods
A total of 80 patients with left heart failure complicated with pulmonary arterial hypertension was enrolled as the subjects of this study and assigned into an observation group (n=40) and a control group (n=40) using a random number table. The changes in pulmonary arterial hypertension-associated indicators at 3 months after treatment and the alterations in the levels of cardiac function-associated biochemical indicator brain natriuretic peptide (BNP), inflammatory factor tumor necrosis factor alpha (TNF-α), and mean pulmonary arterial pressure during treatment were compared between the 2 groups.
Results
At 3 months after treatment, the pulmonary arterial hypertension-associated indicators human urotensin II and calcitonin gene-related peptide in the observation group were lower and higher, respectively, than those in control group. Moreover, the observation group had significantly lower BNP and TNF-α levels and mean pulmonary arterial pressure than the control group. After intervention, the echocardiographic parameters left ventricular ejection fraction (LVEF), cardiac output (CO), and stroke volume (SV) in both groups were significantly higher than those before intervention, and the observation group had significantly higher LVEF, SV, and CO than the control group after intervention.
Conclusions
Beraprost sodium combined with sildenafil for left heart failure complicated with pulmonary arterial hypertension can effectively improve pulmonary arterial hypertension, alleviate left heart failure, and reduce inflammatory responses, thereby achieving better clinical efficacy in patients.
“…Several systematic and meta-analysis studies have been conducted to determine the effectiveness of sildenafil in various populations [17][18][19][20]. A recent review only evaluated the effects of preoperative sildenafil in PH patients undergoing mitral valve surgery [18] and did not compare the effects of sildenafil when given postoperatively and long term for PH secondary to VHD.…”
Sildenafil is commonly used as off-label medication in Pulmonary Hypertension (PH) secondary to Valvular Heart Disease (VHD). Previously, published systematic review reported the efficacy of sildenafil for PH with VHD specifically in preoperative condition. We conducted this systematic review and meta-analysis to summarize the potential benefits of sildenafil at different treatment phases, namely acute or chronic. Articles available up to June 2020 were identified using Web of Science, Ovid & Medline, EBSCOHOST, the Cochrane Library, PubMed and Google scholar. Quality assessment and data analysis were conducted using Review Manager (RevMan) version 5.4 and Black and Downs' Checklist. A total of nine studies (n = 614 patients) were eligible for analysis. Sildenafil improved systolic pulmonary arterial pressure (sPAP) (MD -5.89 mmHg ± 17.07), mean Pulmonary Arterial Pressure (mPAP) (MD -4.62 mmHg ± 12.24) and Pulmonary Vascular Resistance Index (PVRI) (MD -60.11 dynes.sec.cm 5 m 2 ± 500.85) during acute and chronic phase in three studies. Data showed no changes in systemic hemodynamic during acute phase but improved in CO and Cl readings during chronic phase. Sildenafil reduced mechanical ventilation time and post-operative recovery room stay during acute and chronic phases. Patients required inotrope support were similar between placebo and sildenafil groups during acute phase (RR, 0.51%; 95% Cl, 0.21-1.27); P = 0.15: no heterogeneity). Sildenafil has little or no effect on pulmonary and systemic hemodynamic, perioperative monitoring, 6MWT and composite clinical score whether it is given as preoperative or postoperative during acute or chronic treatment phase.
“…1 The most common cause of pulmonary hypertension worldwide is left heart disease 2 amongst which valvular heart disease is the leading cause of secondary pulmonary hypertension. 3 Patients with symptomatic mitral valve disease are severely affected by pulmonary hypertension and upto 65% of patients with symptomatic mitral stenosis 4,5 have increased risk of morbidity and mortality during mitral valve replacement (MVR). 6 Mitral stenosis results in increase in left atrial pressures causing reversible increase in pulmonary arterial pressures 7 Immediately after MVR, pulmonary arterial pressure does not usually regress completely and persist in about 75% of patients having pre-operation severe pulmonary hypertension 8 Milrinone is a phosphodiesterase inhibitor which is commonly used in such patients during weaning from cardiopulmonary bypass, to reduce the pulmonary vascular resistance 9 Milrinone reduces biventricular filling pressures and afterload by systemic and pulmonary vasodilation.…”
Objective: To determine the role of perioperative milrinone on pulmonary hypertension in patients with mitral valve disease undergoing mitral valve replacement surgery. Study Design: Randomized Control Trial. Setting: Department of Cardiac Surgery, Faisalabad Institute of Cardiology, Faisalabad. Period: June 2019 to June 2020. Material & Methods: A total of 80 patients with mitral valve disease who underwent mitral valve replacement were included. The patients were divided into a control group of 40, who were not administered milrinone, and a study group of 40 who received milrinone perioperatively. TVPG, LVEF and NYHA class were recorded preoperatively and postoperatively and were compared. Results: In the study group, postoperative LVEFs and NYHA class were not statistically significant in both groups while postoperative TVPG was significantly lower in study group as compare to control group and is statistically significant (P<0.001). Conclusion: Our study concludes that milrinone can be used as an effective therapy to reduce pulmonary pressure in patients with pulmonary hypertension undergoing mitral valve replacement surgery.
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