[Effectiveness of prostaglandin treatment in idiopathic pulmonary hypertension]

Calcium channel blockers are the only vasodilators that proved their efficiency in idiopathic pulmonary hypertension (IPH). However, not every patient is responsive to this therapy. Only in isolated cases of IPH was proved the good effect of prostaglandins in lowering the pulmonary pressure by inhibiting the proliferation of smooth muscle cells. The follow up of a patient, male, 66 years, with IPH, NYHA IV class global cardiac decompensation, mostly the right heart, cyanotic, with 85% SaO2 at rest, massive edema, with "hair cut" aspect of pulmonary circulation, cardiomegaly assessed radiologically (CTI 0.55) and echocardiographically (important dilation of right heart chambers, RV 50/44 mm, compressing the left heart chambers, IVth grade tricuspid insufficiency and 160/90 mmHg pulmonary pressure) is presented. It was excluded a secondary cause of pulmonary hypertension, both by echocardiography and by cardiac catheterization, which eventually confirms the angiographic diagnosis of IPH (dilation of pulmonary artery and its branches, with no peripheral circulation). The progress was spectacular after introducing iloprost as therapy (two i.v. sessions at one month interval (28 days))--excellent clinical amelioration until IInd NYHA class, 96% SaO2 at rest, disappearance of pleural and pericardial effusion, with the diminishing of heart dimensions in radiological (CTI 0.44) and echography exams (RV 46/38 mm), amelioration of tricuspid regurgitation (grade II) and also the significant decrease of pulmonary pressure (90/60 mmHg).

The therapy with iloprost is particularly effective in treating IPH.