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Sildenafil for Acute Pulmonary Hypertension in a Patient with Aortic Dissection, Mechanical Aortic Valve, and Left Ventricular Dysfunction

Samir Sultan

Singh Digvijay

Timothy Barreiro

David Gemmel


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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

Samir Sultan DO1, MS, Digvijay Singh MD, FCCP2,3., Timothy J Barreiro, DO2,3,4

David Gemmel, PhD4

1. Transitional Residency, St. Elizabeth Health Center, Youngstown, OH
2. Department of Internal Medicine, Division of Pulmonary/Critical Care. St. Elizabeth Health Center, Youngstown, OH
3. Department of Medicine, Northeastern Ohio Medical University, Rootstown, OH
4. Department of Medical Education and Research, St. Elizabeth Health Center, Youngstown, OH

BACKGROUND: Pulmonary hypertension is defined as mean pulmonary artery pressure greater than 25 mmHg at rest or Doppler echocardiogram systolic pressure greater than 40 mmHg. Symptoms of pulmonary hypertension occur from varying reasons including compromised cardiac function, hypoxemia, and arterial remodeling all leading to decreased ability to maintain functional status. We report a 50 year old man with a of BMI 24, with no obstructive sleep apnea, chronic obstructive pulmonary disease, or connective tissue disorder who was status/post repair of acute Type I aortic dissection, followed by balloon angioplasty for in stent thrombosis with progressive dyspnea. Extensive work up for post operative dyspnea revealed acute pulmonary hypertension which was successfully treated with sildenafil 25mg BID.

METHODS: Evaluation using sildenafil 25mg BID for treatment of post Type I acute aortic dissection pulmonary hypertension, using TTE, and NICOM to record cardiac parameters was performed. 6MWT and NYHA functional classification was also undertaken.

RESULTSMarked symptomatic and cardiac parameter improvement was noted with use of sildenafil 25mg BID as evident by increase in cardiac index on ambulation using NICOM (Fig.1and 2). NYHA functional classification improved from IV at baseline to Class I at discharge. Normalized pulmonary artery pressure was also noted on repeat transthoracic and transesophageal echocardiogram 6 weeks after initiation of daily sildenafil therapy (Fig 3). Improved functional status (6MWT) and change in NYHA class improvement were observed long-term (Fig 3). The patient was able to be discharged to home after a brief time in rehabilitation.

CONCLUSIONSAortic dissection and aortic valve repair are both noted as rare causes of acute pulmonary hypertension. In this novel setting of acute pulmonary hypertension the use of sildenafil as a therapeutic option is proposed for further evaluation. This is the first reported use of NICOM confirmed improvement of acute pulmonary hypertension following sildenafil treatment in such a complex patient.