ABSTRACT
Objective To explore the clinical effect of bosentan combined with vardenafil on postoperative pulmonary hypertension associated with congenital heart and its influence on function of vascular endothelium.Methods 80 congenital heart disease patients with postoperative pulmonary hypertension,who were treated in our hospital from November,2011 to December,2015 were enrolled in the present study.They were randomly divided into observation group and control group,with each group of 40 cases.Both group received conventional therapy of oxygen and dieresis.The clinical effect,clinical symptom improvement,cardiac function were compared between the two groups.Results The clinical effect of control group was 80.0％ (32/40),which was significantly lower than that of observation group (90.0％,P ＜ 0.05).The sPAP,mPAP in both group were significantly decreased,and the Qp/Qs level was obviously increased (P ＜ 0.05);Borg score and NYHAFC score as well as the level of VEGF were largely decreased,and those of observation group were significantly lower than control group (P ＜ 0.05).In the terms of adverse reactions,there was no statistical difference between the two groups.Conclusion Bosentan combined with vardenafil was effective on postoperative pulmonary hypertension associated with congenital heart,which can significantly improve the clinical symptoms of patients with dyspnea,improve the cardiac function,worthy of clinical promotion.
ABSTRACT
Objective To observe before and after surgery plasma vascular endothelial growth factor (VEGF) and transforming growth factor beta 1 (TGF-β1) content changes in the children with congenital heart disease(CHD) combined severe pulmonary arterial hypertension(PAH),and to explore the relationship with the pulmonary artery pressure.Methods Sixty cases patients with CHD in the First Hospital of Hebei Medical University from June 2014 to January 2015 were selected,including 30 cases left to right shunt CHD with severe PHD,30 cases no PHD.The content of serum VEGF,TGF-β1,parallel echocardiographic estimates pulmonary artery mean pressure(PAMP) of all children were detected with preoperative and postoperative 24 h,7 d and 30d.Results PAMP of children with severe PAH before surgery was (60.29±8.48) mmHg and (48.36±5.25)mmHg of postoperative 24 h,(28.21±3.29) mmHg of 7 d after surgery,(25.21±2.09) mmHg of 30 d after surgery,the difference was statistically significant (F within the grouP=39.86,P＜0.001),and compared with no PHD group,the difference was significant ((14.26±1.78) mmHg,(14.30±1.92) mmHg,(13.31±1.02)mmHg;F between groups=46.01,P＜0.001).The levels of VEGF and TGF-β1 in severe PHD group were (808.90±41.37) ng/L and (1156.96±83.68) ng/L of before operation,(620.21±30.30) ng/L and (906.20±65.11) ng/L of postoperative 24 h,(454.49±21.48) ng/L and (826.23±35.11) ng/L of postoperative 7 d,(454.49±21.48) ng/L and (806.49±29.48) ng/L of postoperative 30 d,the differences were significant (Fwithin the grouP=43.73,P＜0.001;F within the grouP=65.41,P＜0.001),compared with no PHD group,the differences were significant (VEGF:(379.25±20.21) ng/L,(380.05±19.98) ng/L,(380.05±19.98) ng/L,F between groups =54.09,P＜0.001;TGF-β1:(728.56±29.93) ng/L,(728.11±25.26) ng/L,(727.05±24.99) ng/L,F between groups=83.05,P＜0.001).Conclusion Plasma VEGF and TGF-β1 level has correlation with pulmonary artery pressure,the severity evaluation of pulmonary hypertension and surgical curative effect has a certain significance.After surgery,severe PAH is still exist in a certain period in children with pulmonary hypertension,sufficient attention should be paid to strengthening treatment and follow-up.