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J Thorac Cardiovasc Surg 2005;129:464-466
© 2005 The American Association for Thoracic Surgery

Brief Communications

Vasopressin to attenuate pulmonary hypertension and improve systemic blood pressure after correction of obstructed total anomalous pulmonary venous return

Mark A. Scheurer, MD*, Scott M. Bradley, MD, Andrew M. Atz, MD

Medical University of South Carolina, Charleston, SC

Received for publication April 26, 2004; accepted for publication June 14, 2004.

* Address for reprints: Mark A. Scheurer, MD, 165 Ashley Ave, PO Box 250915, Charleston, SC 29425 (E-mail: scheure@musc.edu).

The first 20% of the full text of this article appears below.

Pulmonary hypertension remains a major contributor to morbidity in the postoperative course of patients after successful surgical correction of obstructed total anomalous pulmonary venous return (TAPVR). Additionally, the postcardiotomy syndrome of low systemic vascular resistance and low cardiac output often necessitates aggressive vasopressor and inotropic support. Vasopressin has been prospectively shown in both adults and children to decrease the need for vasoactive medications in the postcardiotomy syndrome. In animal models of hypoxic pulmonary constriction, vasopressin has been shown to have properties of pulmonary vasodilation as well as systemic vasoconstriction. We hypothesized that vasopressin might decrease pulmonary vascular resistance (PVR) and thus decrease the need for vasoactive medications after surgical correction of TAPVR.


   Clinical summaries
 
Patient 1
A 36-week gestation 2.3-kg female infant with obstructed supracardiac TAPVR underwent complete repair on the second day after birth. After weaning from cardiopulmonary bypass, pulmonary arterial pressure (PAP) increased to suprasystemic levels. Nitric oxide (NO) was initiated at 40 ppm. On arrival in the pediatric cardiac intensive care unit, the patient had a PAP of 51/21 mm Hg (65% systemic) and was receiving dopamine (10 µg · kg–1 · min–1), epinephrine (0.03 µg · kg–1 · min–1), and milrinone (0.5 µg · kg–1 · min–1). Management included hyperventilation, hyperoxygenation, paralysis, and sedation. Epinephrine was gradually increased to 0.1 µg · kg–1 · min–1 . . . [Full Text of this Article]






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