Tratamiento con oxido nitrico, levosimendan y sildenafilo en paciente con disfuncion ventricular derecha e hipertension pulmonar severa tras cirugia cardiaca.

Autors de IIS La Fe

• Ana Isabel Aleixandre López

  Autor

• Jose Cortell Ballester

  Autor

• Rosario Vicente Guillen

  Autor

• Pablo Herrera Melian

  Autor

• Jose María Loro Represa

  Autor

• Francisco José Valera Martínez

  Autor

Grups d'Investigació

• Anestesia y Cuidados Críticos

  Investigador Principal

  María Azucena Pajares Moncho

• Regeneración y Trasplante Cardíaco

  

  Leader

  Pilar Sepúlveda Sanchis

Abstract

Pulmonary hypertension (PHT) and the resulting right ventricle dysfunction are important risk factors in patients who undergo cardiac surgery. The treatment of PHT and right ventricle dysfunction should be focused on maintaining the correct right ventricle after load, improving right ventricle function and reducing the right ventricle pre-load and therefore reducing pulmonary vascular resistance by means of vasodilators. A combined therapy of vasodilators and medicines which have different mechanisms of action, is becoming an option for the treatment of PHT. We present a 65 year old woman that suffered from mitral regurgitation, aortic valve disease, tricuspid and ascending aortic dilation with 115mmHg of pulmonary artery pressure (by ultrasound evaluation). The patient was operated on of mitral, aortic valve and tricuspid plastia and proximal aortic artery plastia as well. Previosly to surgery the patient suffered right ventricle dysfunction and PHT and was treated with nitric oxide, intravenous sildenafil and levosimendan. Subsequent evolution was satisfactory, PHT being controlled, without arterial hypotension nor respiratory alterations.

Keywords

• Cardiac surgery; Cirugia cardiaca; Disfuncion del ventriculo derecho; Hipertension pulmonar; Levosimendan; Levosimendan; Nitric oxide; Pulmonary hypertension; Right ventricle dysfunction; Sildenafil; Sildenafilo; Oxido nitrico