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Hemodynamic effects of nifedipine and oxygen in children with pulmonary hypertension
M Wimmer1, M Schlemmer, F Ebner
1Department of Pediatrics, University of Vienna, Austria.
Insights
Nifedipine administered into the pulmonary artery effectively reduced pulmonary arterial pressure and increased blood flow in pediatric patients with pulmonary hypertension. This treatment showed a more pronounced and selective benefit compared to oxygen therapy.
Area of Science:
- Pediatric Cardiology
- Pulmonary Hypertension Research
- Pharmacodynamics
Background:
- Pulmonary hypertension in children, including primary forms and secondary to congenital heart disease (CHD) with shunts, presents significant therapeutic challenges.
- Effective management strategies for pediatric pulmonary hypertension require agents with selective action on the pulmonary vasculature.
Purpose of the Study:
- To evaluate the hemodynamic effects of intrapulmonary artery nifedipine administration in pediatric patients with pulmonary hypertension.
- To compare the efficacy of nifedipine with oxygen breathing in this patient population.
Main Methods:
- Hemodynamic parameters including pulmonary arterial pressure and flow were measured before and after incremental doses of nifedipine (0.5 and 1 microgram/kg) via pulmonary artery injection in 14 pediatric patients.
- Effects of nifedipine were compared to those of 100% oxygen breathing in a subset of eight patients.
Main Results:
- Nifedipine administration resulted in a statistically significant reduction in mean pulmonary arterial pressure (p<0.05) and a significant increase in pulmonary flow index (p<0.005).
- No significant changes were observed in heart rate or systemic systolic blood pressure.
- Nifedipine demonstrated a more pronounced and selective beneficial effect on the pulmonary vascular bed compared to oxygen therapy.
Conclusions:
- Intrapulmonary artery nifedipine is a safe and effective treatment for reducing pulmonary arterial pressure and improving pulmonary blood flow in pediatric patients with pulmonary hypertension.
- Nifedipine offers a selective advantage over oxygen in managing pulmonary hypertension associated with CHD and shunts.
Abstract:
Fourteen patients, 2 to 20 years old were investigated. Two had primary pulmonary hypertension, 11 had congenital heart disease and post-tricuspid shunts, and 1, a 20-year-old patient, was investigated after he had undergone surgical correction of truncus arteriosus I. Pulmonary arterial pressure, pulmonary flow index, peripheral systolic blood pressure and heart rate were measured before, and several times after intrapulmonary injection into the pulmonary artery of 0.5 microgram nifedipine/kg. Six patients were given an additional dose of 1 microgram nifedipine per kilogram into the pulmonary artery and hemodynamic measurements were repeated. In eight children, receiving 100% oxygen via a breathing mask, nifedipine effects were compared with oxygen effects. After 10 minutes under oxygen, the same hemodynamics were determined as after nifedipine. In addition, in four of these children aortic pressure and arterial oxygen saturation were also measured. Maximal effects occurred within 4 minutes. 0.5 micrograms nifedipine per kilogram caused a slight reduction in mean pulmonary arterial pressure (p less than 0.05), as well as increase in pulmonary flow index (p less than 0.005). However, no significant change in heart rate or in systolic blood pressure was observed. 1 microgram nifedipine per kilogram IP had almost the same effects. No adverse side effects occurred, besides mild headaches in one child. A comparison of nifedipine injected into the pulmonary artery with oxygen breathing in congenital heart disease combined with pulmonary hypertension, is reported for the first time. Nifedipine had a more pronounced and beneficial effect with a selective action on the pulmonary vascular bed.