[Afterload reduction therapy with prostaglandin E1 (PGE1)]

Increases in afterload cause marked decreases in cardiac output and left ventricular stroke volume in patients with congestive heart failure. We studied the effects of afterload reduction therapy with prostaglandin E1 in three patients with intraoperative heart failure and two patients with low output syndrome after coronary artery bypass grafting. After 120 minutes, mean pulmonary arterial pressure decreased from 25.6 to 17.4 mmHg, pulmonary wedge pressure from 20.0 to 10.2 mmHg and right atrial pressure from 10.2 to 6.8 mmHg. Cardiac index increased from 1.73 to 2.80 l.min-1.m-2. The improvement of peripheral circulatory failure was remarkable and all patients recovered from heart failure. This study suggests that PGE1 is effective for afterload reduction therapy.