Ciddi Pulmoner Hipertansiyonlu Komplet Atriyoventriküler Kanal Defekti Onarımından Sonra Kombine İnhale Nitrik Oksit ve Oral Sildenafil Kullanılması: Vaka Sunumu ve Literature Taraması

Year 2017, Volume: 7 Issue: 4, 246 - 250, 04.01.2018

Elif Demirbaş Figen Akalın Alper Kararmaz Selim İsbir Sinan Arsan Koray Ak

https://doi.org/10.31832/smj.320403

Abstract

Down
sendromu ve komplet tip atrioventriküler septal defekt (KAVSD)
tanılarıyla takip edilen 12 aylık erkek hasta tam düzeltme
operasyonu sonrası postoperatif dönemde pulmoner hipertansif kriz
yaşadı. Pulmoner hipertansif kriz inhale nitrik oksit (iNO)
tedavisi ile (40-60 ppm) başarılı bir şekilde kontrol edildi.
Takiplerinde methemoglobinemi gelişen hastada iNO dozu 24 saat sonra
azaltılmak zorunda kalındı (10 ppm). Tedaviye sildenafil tablet (6
mg/kg/gün) eklenmesi ile postoperatif pulmoner hipertansif krizler
kontrol altına alındı. Konjenital kalp cerrahisinde pulmoner
hipertansif krizlerin engellenmesinde ve yan etkilerin kontrol
edilmesinde kombine tedaviler etkili yöntemlerdir. 

Keywords

postoperatif pulmoner hipertansiyon, konjenital kardiyak cerrahi, inhale nitrik oksit, sildenafil

Combined Use of Inhaled Nitric Oxide and Oral Sildenafil After Repair of Complete Atrioventricular Canal Defect with Severe Pulmonary Hypertension : Report of A Case and Review of Literature

Abstract

A
12 month old male baby with diagnoses of Down syndrome and complete
atrioventricular canal defect underwent total correction. His early
postoperative course was complicated with pulmonary hypertensive
crises. It was initially treated by 40-60 ppm inhaled nitric oxide
(iNO), but we had to decrease the dosage because of serum increased
methemoglobin levels after 24 hours of treatment (10 ppm). We added
oral sildenafil sitrate as a combination therapy (6 mg/kg/day) which
was seemed to be effective in controlling pulmonary hypertensive
crises. Combined regimens like iNO and sildenafil for postoperative
pulmonary hypertensive crises are beneficial in terms of reducing the
dosage of iNO and preventing rebound pulmonary hypertension.

Keywords

postoperative pulmonary hypertension, congenital cardiac surgery, inhaled nitric oxide, sildenafil

References

• Kaynaklar 1.Sungur M, Ocal B, Oguz D, Karademir S, Karakurt C, Senocak F. Plasma endothelin 1 and nitrate levels in Down's syndrome with complete atrioventricular septal defect associated pulmonary hypertension: a comparison with non-Down's syndrome children. Eur J Pediatr 2009; 168:593–7. 2.Lindberg L, Olsson AK, Jögi P, Jonmarker C. How common is severe pulmonary hypertension after pediatric cardiac surgery ?. J Thorac and Cardiovasc Surg 2002; 123:1155-63. 3.Mossad EB. Pro:Intraoperative use of nitric oxide for treatment of pulmonary hypertension in patients with congenital heart disease is effective: J Cardiothorac and Vasc Anesth 2001; 15:259-62. 4.Hopkins RA, Bull C, Haworth SG, Level MR, Stark J. Pulmonary hypertensive crises following surgery for congenital heart defects in young children. Eur J Cardiothorac Surg.1991; 5:628-34. 5.Şaşmazel A, Adademir T, Baysal A, Öner N, Özkökeli M, Yılmaz E, et al. Doğuştan kalp cerrahisi sonrası inhale nitrik oksit tedavisinin kesilmesine yardımcı oral sildenafil kullanımı: Klinik deneyimlerimiz . Türk Göğüs Kalp Damar Cerrahisi Dergisi, Ekim 2011; 4:518-523. 6.Galie N, Humbert M, Vachiery J, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 2016; 37 (1): 67-119 7.Diker E, Aydoğdu S. Oral sildenafil sitratın sıradışı bir kullanımı. Arch Turk Soc Cardiol 2002; 30:208-210 8.Özkan M, Yüksekol I. Nitrik Oksit ve Akciğerler. Türk Toraks Cerrahisi Dergisi, Nisan 2003; 1: 088-094 9.Breuer J, Prein W, Gebhardt S, Knies R, Sieverding L, Baden W,Apitz J. Inhaled Nitric oxide treatment of children with pulmonary hypertension after cardiac surgery. Progress in Pediatric Cardiology, March 1999; 9:73-83 10.Journois D, Baufreton C, Mauriat P,Pouard P, Vouhei P, Safran D. Effects ıf inhaled nitric oxide administration in patients operated for correction of atrioventricular canal defects. Chest, November 2005; 128:3537-44. 11.Ichinose F, Roberts JD, Zapol WM. Inhaled Nitric Oxide-A Selective Pulmonary Vasodilator: Current Uses and Therapeutic Potential. Circulation, June 2004; 109:3106-11. 12.Hill NS, Roberts KR, Preston IR. Postoperative Pulmonary Hypertension:Etiology and Treatment of a Dangerous Complication. Respir Care, July 2009; 54(7):958-68. 13.Lee JE , Hillier SC. Knoderer CA. Use of sildenafil to facilitate weaning from inhaled nitric oxide in children with pulmonary hypertension following surgery for congenital heart disease. J Intensive Care Med. Sep-Oct 2008; 23:329-34.