ROLE OF SILDENAFIL IN MANAGEMENT OF POST-OPERATIVE PULMONARY HYPERTENSION IN CHILDREN.

Umair Younus*, Iftikhar Ahmed, William M.Novick, Syed Aqeel Hussain, Rashad Siddiqi, Nadeem Sadiq, Frank L. Molloy and Thomas G. Di Sessa

ABSTRACT

Objective: To evaluate the effectiveness of oral sildenafil on post-operative pulmonary hypertension in children following surgery for congenital heart disease. Study design: Retrospective Analytical study Patients and Methods: Fifty four consecutive patients between 2005 and 2013 with congenital heart defects (ventricular septal defects and patent ductus arteriosus) with systemic or supra systemic pulmonary artery pressures post operatively were included in the study. In all these patients sildenafil was given post operatively and the Ratio of pulmonary artery pressures to systemic pressures was recorded and presented as a percentage. These pressures were recorded at 0, 1, 6, 12 and at 24 hours intervals. After discharge pulmonary artery pressures were calculated by transthoracic echocardiography at 3 and 6 months and at one year. Results: The age of patients ranged from 1 to 28 years (mean of 7.2 ± 6.1 years) and 53.7%(n=29) were male. The mean PA pressures were 90.52±17.19 percent of aortic pressures pre-operatively, which dropped to 57.94 (+/- 12.60) percent of aortic pressures after 24 hours (p<0.001) with sildenafil therapy. A further decrease in pulmonary artery pressures was seen at 3 months (42.29 +/- 13.59) percent of aortic pressures, at 6 months (34.23 +/- 14.60) percent of aortic pressures. After 1 year the PA pressures were 31.17 (+/- 15.42) percent of aortic pressures. Conclusion: Oral sildenafil is readily available and effective as an adjunctive agent in the treatment of post operative pulmonary hypertension.

Keywords: Pulmonary Hypertension, Sildenafil, Congenital Heart Disease, Ventricular Septal Defect, Patent Ductus Arteriosus.