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Aerosolized iloprost for severe pulmonary hypertension as a bridge to heart transplantation

T Wittwer1, K Pethig, M Strüber

  • 1Department of Thoracic, Medical School Hannover, Germany. th.wittwer-md@t-online.de

The Annals of Thoracic Surgery
|March 28, 2001
PubMed

Insights

Preexisting pulmonary hypertension poses risks for pediatric heart transplant recipients. Intensified prostacyclin and dobutamine pretreatment stabilized a patient, enabling successful cardiac transplantation without combined heart-lung procedures.

Area of Science:

  • Cardiology
  • Pulmonology
  • Transplantation Medicine

Background:

  • Pediatric patients with preexisting pulmonary hypertension face poor outcomes after cardiac transplantation.
  • Donor right ventricular dysfunction is a significant contributing factor to adverse outcomes.

Observation:

  • A 17-year-old patient with pulmonary hypertension required cardiac transplantation.
  • Combined heart-lung transplantation was considered to manage the high pulmonary vascular resistance.

Findings:

  • An intensified pretreatment regimen was administered, including intravenous prostacyclin and dobutamine.
  • Inhalative therapy with the prostacyclin analog Iloprost was also used.
  • This comprehensive approach led to hemodynamic stabilization of the patient.

Implications:

  • The successful hemodynamic stabilization allowed for a 21-day waiting period for the cardiac transplant.
  • An uneventful cardiac transplantation was subsequently performed, avoiding the need for combined heart-lung transplantation.
  • This strategy offers a potential alternative for managing pediatric heart transplant candidates with severe pulmonary hypertension.

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