effect of tadalafil on right ventricular function in patient with pulmonary hypertension undergoing mitral valve surgery assessed by tissue doppler and TEI index

Pulmonary artery hypertension is a disorder with limited treatment options and poor prognosis. We studied the effect of tadalafil, a selective phosphodiesterase type 5 inhibitor, in patients with this disease. In fifty patients subjected to mitral valve surgery [26 males, 24 females] aged 19040 years, with pulmonary artery hypertension, 10 mg tadalafil single dose was given to 25 patients after induction of anesthesia, and its effect was compared to a placebo given to the other 25 patients, all fifty patients had a comprehensive Transoesophageal echo examination including tissue Doppler and Tie index. Tadalafil resulted in a marked improvement in right ventricular function as regards tissue Doppler and Tie index [0.3110.05] compared to [0.34 +/- 0.02] in control group [p value =0.01] and pulmonary artery pressure [52.6 +/- 12.17] compared to control group [59.60 +/- 11.31] [p value =0.04]. 10 mg Single dose tadalafil was well tolerated and had a beneficial effect in patients with pulmonary artery hypertension undergoing mitral valve surgery

The Effect of Milrinone on the Right Ventriclular Function in Patients with Reduced Right Ventricular Function Undergoing Off-pump Coronary Artery Bypass Graft Surgery

This investigation evaluated the effect of continuous milrinone infusion on right ventriclular (RV) function during off-pump coronary artery bypass graft (OPCAB) surgery in patients with reduced RV function. Fifty patients scheduled for OPCAB, with thermodilution RV ejection fraction (RVEF) <35% after anesthesia induction, were randomly allocated to either milrinone (0.5 microgram/kg/min) or control (saline) group. Hemodynamic variables and RV volumetric data measured by thermodilution method were collected as follows: after anesthesia induction (T1); 10 min after heart displacement for obtuse marginal artery anastomosis (T2); after pericardial closure (T3). Cardiac index and heart rate increased and systemic vascular resistance significantly decreased in milrinone group at T2. Initially lower RVEF of milrinone group was eventually comparable to control group after milrinone infusion. RVEF did not significantly change at T2 and T3 in both groups. RV end-diastolic volume in milrinone group consistently decreased from the baseline at T2 and T3. Continuous infusion of milrinone without a bolus demonstrated potentially beneficial effect on cardiac output and RV afterload in patients with reduced RV function during OPCAB. However, aggressive augmentation of intravascular volume seems to be necessary to maximize the effect of the milrinone in these patients.

Sildenafil melhora a função ventricular direita no receptor de transplante cardíaco / Sildenafil improves right ventricular function in a cardiac transplant recipient

Relatamos caso de um paciente submetido a transplante cardíaco ortotópico, onde se utilizou um doador marginal pela piora clínica do receptor, que apresentava choque cardiogênico por disfunção de ventrículo direito secundária a hipertensão pulmonar associado à vasoplegia. Obtivemos recuperação hemodinâmica do paciente, com redução da resistência vascular pulmonar, retirada de drogas vasoativas e recuperação da função do ventrículo direito após a introdução de sildenafil.

Hemodynamic evaluation of right ventricular function in chronic obstructive airway disease before and after beta 2 mimetics

This study assessed the effects of IV terbutaline [Bricanyl] as a prototype of beta 2 mimetics on cardiorespiratory function in 20 patients with COPD [16 males, 4 females]. Arterial blood gases on admission showed a mean PO2 of 124 mmHg and a mean PCO2 of 59 mmHg. 14 out of 20 patients were on assisted ventilation. All patients were subjected to cardiac catheterization using flow directed Swan Ganz catheter. Baseline evaluation was followed by hemodynamic measurements. Beta mimetic therapy increased HR by 23%, BP by 11% and PCWP by 27%, while there was almost no effect on CVP. Intravenous Bricanyl significantly augmented CI, SVI and increased LVSWI and RVSWI. IV Bricanyl substantially increased SaO2, SVO2, O2 transport and O2 uptake without significantly changing O2 extraction ratio. The increase in the SVSWI was highly significant compared with the modest increase in LVSWI