The Heart Valve Society

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Benefits Of Oral Sildenafil Administration To Patients With Mitral Stenosis And Severe Pulmonary Hypertension Undergoing Mitral Valve Replacement
Sherif A. Mansour, Ashraf El Midany, Ahmed M. Habib.
Ain Shams University, Cairo, Egypt.

OBJECTIVE: Mitral valve disease notably the predominant stenotic lesion is a long standing disease and in developing countries late detection results in increase association with severe pulmonary hypertension. RV failure is a leading cause of increased morbidity and mortality of patients with severe pulmonary hypertention undergoing mitral valve surgery. Sildenafil (Phosphodiesterase inhibitor type 5)has been successfully used to treat primary pulmonary hypertension.
The study aims to confirm the effectiveness of preoperative oral sildenafil in decreasing the incidence of RV failure in patients suffering from severe pulmonary hypertension undergoing mitral valve replacement surgery
METHODS: A total of 80 patients who were scheduled for mitral valve replacement surgery with severe PAH, RV systolic pressure (RVSP) ≥60mmHg, as measured by preoperative transthoracic echocardiography, were included in the study. Patients were randomized by sealed envelope method into two groups: Gr C - placebo (N = 40), and Gr S - Sildenafil ( N = 40) with oral sildenafil 25 mg eight hourly for 48 h before surgery with the last dose given 25mg in 10ml via nasogastric tube after induction of anaesthesia .In both group the need to administration of inotropes including adrenaline, noradrenaline, milrinon ,or, dobutrex were recorded and doses were titrated to achieve haemodynamic stability during and after CPB.
RESULTS: Pulmonary artery pressure was signifcantly reduced in the sildenafil group.
Ventilation time was less in the sildenafil group but without statically significant value, CPB time was significantly lower in the sildenafil group (p = 0.05) and postoperative ITU stay was significantly lower (P < 0.001) in sildenafil group. The requirements of inotropes notably dobutrex and milrinon were significantly more with placebo group compared to sildenafil group. No complication related to use of sildenafil were observed. CONCLUSIONS: Sildenafil significantly reduced the pulmonary pressure in mitral valve replacement patients with severe pulmonary hypertension. hence reduced the strain of the right ventricle which facilitated weaning from CPB with reduced need for inotropic support.It is concluded that sildenafil is safe and effective medication to be used to reduce severe pulmonary hypertension when given to patients prior to the mitral valve replacement surgery.


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