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Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors

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Phosphodiesterase 5 (PDE5) inhibitors are potent enzymes that function to hydrolyze cyclic nucleotides to their corresponding 5' monophosphates. Their unique biochemical properties have been applied in treating Pulmonary Arterial Hypertension (PAH).
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...

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Is it really PPHN? Think before starting sildenafil!

Munesh Tomar¹, Pankaj Bajpai

¹Department of Pediatric Cardiology, Medanta-The Medicity, Gurgaon, Haryana. India. drmuneshtomar@gmail.com

Indian Pediatrics

|January 15, 2013

Summary

Sildenafil is commonly used for pulmonary hypertension in NICUs due to limited specialist access. However, some severe cases stem from rare causes not needing vasodilator drugs.

Area of Science:

Neonatal Cardiology
Pediatric Critical Care
Pharmacology

Background:

Sildenafil is frequently administered in neonatal intensive care units (NICUs) for pulmonary arterial hypertension.
Limited availability of pediatric cardiologists, especially in peripheral centers, often necessitates empirical treatment.
Clinical decisions for sildenafil use are common due to these access challenges.

Observation:

This experience highlights severe pulmonary arterial hypertension cases.
These cases were attributed to unusual hemodynamic patterns or rare structural anomalies.
The identified causes did not necessitate pulmonary vasodilator therapy.

Findings:

Severe pulmonary arterial hypertension can arise from uncommon hemodynamic conditions.

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Extremely rare structural causes of pulmonary hypertension exist.

Pulmonary vasodilator therapy is not always required for severe pulmonary arterial hypertension.

Implications:

Clinicians should consider alternative etiologies for severe pulmonary arterial hypertension in neonates.
Diagnostic evaluation beyond standard vasodilator therapy may be warranted.
This underscores the importance of identifying specific causes rather than relying solely on symptomatic treatment.