PROSTAGLANDIN-E1 - A NEW THERAPY FOR REFRACTORY RIGHT HEART-FAILURE AND PULMONARY-HYPERTENSION AFTER MITRAL-VALVE REPLACEMENT

  • 1 January 1985
    • journal article
    • research article
    • Vol. 89  (4) , 567-572
Abstract
Patients undergoing mitral valve replacement, particularly those with severe pulmonary hypertension and/or congestive heart failure, may develop life-threatening right heart failure in the immediate postbypass period. Such patients have intense pulmonary vasoconstriction. The markedly increased pulmonary impedance may aggravate the right heart failure and prevent recovery of right ventricular function in this setting. The effects of high-dose prostaglandin E1 (30 to 150 ng/kg/min), a potent pulmonary vasodilator, in combination with massive infusion of norepinephrine (up to 1 .mu.g/kg/min) into the left atrium was studied in 5 consecutive patients with refractory right heart failure and pulmonary hypertension after mitral valve replacement. This pharmacologic approach takes advantage of the pulmonary vasodilating effects of prostaglandin E1, while offsetting associated systemic vasodilation and resulting hypotension. All 5 patients had rapid pulmonary vasodilator responses followed by marked improvement in right ventricular function. All survived the operation and none had right ventricular infarction or chronic right heart failure postoperatively.