JTCS Tips for Better Browsing
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Jae Kwang Shim
Dae Hee Kim
Yong Woo Hong
Young Lan Kwak
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Shim, J. K.
Right arrow Articles by Kwak, Y. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Shim, J. K.
Right arrow Articles by Kwak, Y. L.
Related Collections
Right arrow Valve disease

J Thorac Cardiovasc Surg 2006;132:1420-1425
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Effect of oral sildenafil citrate on intraoperative hemodynamics in patients with pulmonary hypertension undergoing valvular heart surgery

Jae Kwang Shim, MDa, Yong Seon Choi, MDa, Young Jun Oh, MDa,b, Dae Hee Kim, MDa, Yong Woo Hong, MD, PhDa,b,c, Young Lan Kwak, MD, PhDa,b,c,*

a Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
b the Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
c Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.

Received for publication June 9, 2006; revisions received July 14, 2006; accepted for publication August 25, 2006.

* Address for reprints: Young Lan Kwak, MD, PhD, Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Ku, Seoul, South Korea, 120-725. (Email: ylkwak{at}yumc.yonsei.ac.kr).

OBJECTIVE: Pulmonary hypertension remains a major problem during the perioperative period for surgical correction of long-standing valvular heart disease. Sildenafil citrate (INN sildenafil) is a selective phosphodiesterase type 5 inhibitor that is being increasingly recognized as a treatment modality for pulmonary hypertension. There is lack of evidence, however, regarding its pulmonary vasodilatory effect in anesthetized cardiac surgical patients. We therefore evaluated the effects of sildenafil on hemodynamics in patients with concomitant pulmonary hypertension undergoing valvular heart surgery in a controlled, prospective, randomized, double-blind trial.

METHODS: Fifty-three patients scheduled for valvular heart surgery with mean pulmonary arterial pressure greater than 30 mm Hg were randomly treated with either 50 mg oral sildenafil (n = 26) or placebo (n = 27) 10 minutes before induction of anesthesia. Hemodynamic variables were measured 5 minutes after induction of anesthesia (baseline) and at 30 and 60 minutes after medication.

RESULTS: Patient characteristics and baseline hemodynamics were similar between groups. Systolic and mean pulmonary arterial pressures and pulmonary vascular resistance were significantly lower in the sildenafil group at 30 minutes after medication, without any changes in mean systemic arterial pressure and systemic vascular resistance.

CONCLUSION: Sildenafil produced significant pulmonary vasodilatory effect relative to placebo in anesthetized cardiac surgical patients with pulmonary hypertension. With respect to the predominant selectivity of sildenafil to pulmonary vasculature shown in this study and other potentially beneficial effects such as myocardial protection, use of sildenafil in the intraoperative period in cardiac surgical patients with pulmonary hypertension should be considered.

Abbreviations and Acronyms cGMP = cyclic guanylate monophosphate; CPB = cardiopulmonary bypass; PAH = pulmonary arterial hypertension; PDE5 = phosphodiesterase type 5; PVRI = pulmonary vascular resistance index; MPAP = mean pulmonary arterial pressure; RV = right ventricle; RVEDVI = RV end-diastolic volume index; RVESVI = RV end-systolic volume index; SPAP = systolic pulmonary arterial pressure; SVRI = systemic vascular resistance index




This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
J. G.T. Augoustides
Intraoperative oral sildenafil for management of pulmonary hypertension: A stepping stone to the future
J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 267 - 267.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
J. K. Shim, Y. S. Choi, and Y. L. Kwak
Reply to the Editor
J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 267 - 268.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The American Association for Thoracic Surgery.