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KMID : 0356920080540010102
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Korean Journal of Anesthesiology
2008 Volume.54 No. 1 p.102 ~ p.108
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Perioperative Combined Use of Sildenafil and Inhaled Iloprost for Moderate Portopulmonary Hypertension in a Patient Undergoing Liver Transplantation
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Kim Duk-Kyung
Kim Hae-Kyoung
Lim Jeong-Ae
Jeong Seung-Min
Jang Sung-Whan
Yun Ik-Jin
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Abstract
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Moderate to severe pulmonary hypertension, mean pulmonary arterial pressure (mPAP) ＞ 35 mmHg, in cirrhotic patients is usually considered an absolute contraindication to orthotopic liver transplantation (OLT) because of unacceptably high mortality. We present the case of successful OLT in a cirrhotic patient with a mPAP of 42 mmHg and a pulmonary vascular resistance (PVR) of 298 dyneㆍsecㆍcm?5 preoperatively. He was treated with oral sildenafil (Viagra?) and inhaled iloprost (Ventavis?) for 45 days and then his mPAP and PVR were reduced to 33 mmHg and 206 dyneㆍsecㆍcm?5 at the time of transplantation. During OLT, his mPAP was stable of 28?38 mmHg with the combined use of sildenafil via a nasogastric tube and iloprost via a nebulizer. His hemodynamic parameters were stable and significant postoperative bleeding was not noticed throughout his stay in the intensive care unit. Thereafter, he was transferred to general ward without any cardio-respiratory problems on 7th postoperative days. (Korean J Anesthesiol 2008; 54: 102∼8)
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KEYWORD
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iloprost, liver transplantation, sildenafil, pulmonary hypertension
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