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Prostaglandin E<inf>1</inf> infusion for right ventricular failure after cardiac transplantation

Vincent, JL and Carlier, E and Pinsky, MR and Goldstein, J and Naeije, R and Lejeune, P and Brimioulle, S and Leclerc, JL and Kahn, RJ and Primo, G (1992) Prostaglandin E<inf>1</inf> infusion for right ventricular failure after cardiac transplantation. Journal of Thoracic and Cardiovascular Surgery, 103 (1). 33 - 39. ISSN 0022-5223

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Abstract

The infusion of prostaglandin E1, a vasodilating substance with predominant effects on the pulmonary vasculature, has been found effective in the management of pulmonary hypertension associated with various diseases. The reported experience with prostaglandin E1 after cardiac transplantation is, however, limited. We used prostaglandin E1 in 18 patients in whom acute right ventricular failure developed after orthotopic cardiac transplantation. The infusion was started within 24 hours after operation in 16 patients and was continued for up to 7 days. Maximal doses of prostaglandin E1, administered via a central venous catheter, ranged from 30 to 120 ng/kg/min. Norepinephrine was simultaneously infused via a left atrial catheter in 10 patients to prevent a reduction in systemic arterial pressure. The prostaglandin E1 infusion resulted in significant reductions in mean arterial pressure and pulmonary vascular resistance and simultaneous increases in cardiac index and stroke index. Mean arterial pressure was stable and left ventricular stroke work increased. The alveolar oxygen tension/forced inspiratory oxygen index tended to decrease during the infusion. Three patients died, two of right heart failure and one of multiple organ failure associated with cardiac allograft rejection. In patients in whom right ventricular failure associated with pulmonary hypertension develops after cardiac transplantation, prostaglandin E1, combined with norepinephrine whenever the arterial pressure declines, can effectively reduce pulmonary artery pressures and improve global cardiac function without compromising systemic perfusion.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Vincent, JL
Carlier, E
Pinsky, MRpinsky@pitt.eduPINSKY
Goldstein, J
Naeije, R
Lejeune, P
Brimioulle, S
Leclerc, JL
Kahn, RJ
Primo, G
Date: 1 January 1992
Date Type: Publication
Journal or Publication Title: Journal of Thoracic and Cardiovascular Surgery
Volume: 103
Number: 1
Page Range: 33 - 39
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0022-5223
PubMed ID: 1728711
Date Deposited: 24 Feb 2012 15:26
Last Modified: 04 Feb 2019 15:57
URI: http://d-scholarship.pitt.edu/id/eprint/11089

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