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) £¾ 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 dyne¤ýsec¤ýcm?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 dyne¤ýsec¤ýcm?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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