[Effect of nebulised iloprost combined with inhaled nitric oxide and oral sildenafil on lung transplant patients. Therapeutic efficacy in pulmonary hypertension during surgery]. / Efecto de iloprost nebulizado combinado con óxido nítrico inhalado y sildenafilo oral en las presiones pulmonares de pacientes sometidos a trasplante pulmonar. Eficacia terapéutica en la hipertensión pulmonar intraoperatoria.

OBJECTIVES: There is a high incidence of pulmonary hypertension during the lung transplant peri-operative period, and could lead to a haemodynamic deterioration that may require the need of extracorporeal circulation. Our aim was to study the haemodynamic effects on the pulmonary and systemic circulation of the combination of inhaled nitric oxide and iloprost and oral sildenafil in patients with severe pulmonary hypertension during lung transplant surgery. PATIENTS AND METHODS: Seventeen patients received 10µg of nebulised iloprost during the peri-operative period of the lung transplant when their mean pulmonary pressure exceeded 50mmHg. AU the patients received 50mg of oral sildenafil 30min before anaesthetic induction, 20ppm of inhaled nitric oxide after tracheal intubation. The haemodynamic and respiratory variables were recorded at baseline (after anaesthetic induction), prior to the administering of iloprost, and at 5 and 30min after it was given. RESULTS: The administering of iloprost significantly reduced the pulmonary arterial pressure and significantly increases the cardiac Índex and the right ventrícular ejection fractíon. There were no signíficant changes occurred in the systemic arterial pressure. CONCLUSIONS: The triple combination significantly reduces the pulmonary pressures in the lung transplant peri-operative and should be considered when there is severe pulmonary hypertension during the surgery or during the immediate post-operative period of lung transplantation.

Efecto de iloprost nebulizado combinado con óxido nítrico inhalado y sildenafilo oral en las presiones pulmonares de pacientes sometidos a trasplante pulmonar. Eficacia terapéutica en la hipertensión pulmonar intraoperatoria / Effect of nebulised iloprost combined with inhaled nitric oxide and oral sildenafil on lung transplant patients. Therapeutic efficacy in pulmonary hypertension during surgery

Objetivos: La presencia de hipertensión pulmonar tiene elevada incidencia durante el perioperatorio del trasplante pulmonar y puede condicionar deterioro hemodinámico que obligue a instaurar circulación extracorpórea. Nuestro objetivo es estudiar los efectos hemodinámicos en la circulación pulmonar y sistémica de la asociación de óxido nítrico e iloprost inhalados y sildenafilo por vía oral en pacientes con hipertensión pulmonar severa durante la cirugía de trasplante pulmonar. Pacientes y métodos: Durante el perioperatorio del trasplante pulmonar, 17 pacientes recibieron 10 mg de iloprost nebulizado cuando su presión arterial pulmonar media superó los 50 mmHg. Todos los pacientes recibieron 50 mg de sildenafilo por vía oral 30 min antes de la inducción anestésica y 20 ppm de NO inhalado tras la intubación traqueal. Se registraron las variables hemodinámicas y respiratorias en los tiempos basal (tras la inducción anestésica), previamente a la administración de iloprost, y a los 5 y 30 min de su administración. Resultados: La administración de iloprost redujo de forma significativa la presión arterial pulmonar e incrementó significativamente el índice cardiaco y la fracción de eyección del ventrículo derecho. No se produjeron modificaciones significativas de la presión arterial sistémica. Conclusiones: La triple asociación reduce significativamente las presiones pulmonares en el perioperatorio del trasplante pulmonar y debe considerarse en presencia de hipertensión pulmonar severa durante la intervención quirúrgica o el postoperatorio inmediato del trasplante pulmonar(AU)

Objectives: There is a high incidence of pulmonary hypertension during the lung transplant peri-operative period, and could lead to a haemodynamic deterioration that may require the need of extracorporeal circulation. Our aim was to study the haemodynamic effects on the pulmonary and systemic circulation of the combination of inhaled nitric oxide and iloprost and oral sildenafil in patients with severe pulmonary hypertension during lung transplant surgery. Patients and methods: Seventeen patients received 10mg of nebulised iloprost during the peri-operative period of the lung transplant when their mean pulmonary pressure exceeded 50 mmHg. All the patients received 50 mg of oral sildenafil 30 min before anaesthetic induction, 20 ppm of inhaled nitric oxide after tracheal intubation. The haemodynamic and respiratory variables were recorded at baseline (after anaesthetic induction), prior to the administering of iloprost, and at 5 and 30 min after it was given. Results: The administering of iloprost significantly reduced the pulmonary arterial pressure and significantly increases the cardiac index and the right ventricular ejection fraction. There were no significant changes occurred in the systemic arterial pressure. Conclusions: The triple combination significantly reduces the pulmonary pressures in the lung transplant peri-operative and should be considered when there is severe pulmonary hypertension during the surgery or during the immediate post-operative period of lung transplantation(AU)

Fibrinólisis con TNK en un caso de trombosis de prótesis valvular mitral / Fibrinolysis with TNK in a case of thrombosis of mitral valvular prosthesis

Se presenta el caso de una mujer de 74 años, portadora de una prótesis valvular mitral (CarboMedics de 27 mm), que ingresa en la Unidad de Cuidados Intensivos en situación de edema agudo de pulmón. Se comprueba disfunción de la prótesis compatible con trombosis, por ecocardiografía transesofágica (ETE), y considerando la situación general de la paciente, se plantea la opción del tratamiento con fibrinolíticos como alternativa a la cirugía. Tras dos dosis sucesivas de 100 unidades por kg de Tenecteplasa, se consigue apertura completa de la prótesis, confirmada por ETE, y una excelente evolución clínica posterior (AU)