Inhaled iloprost in eight heart transplant recipients presenting with post-bypass acute right ventricular dysfunction

Acta Anaesthesiol Scand. 2006 Nov;50(10):1213-7. doi: 10.1111/j.1399-6576.2006.01139.x. Epub 2006 Sep 15.


Background: During heart transplantation, weaning from cardiopulmonary bypass may be particularly laborious as a result of superimposed acute right ventricular dysfunction in the setting of pre-existing pulmonary hypertension. Research in recent years has focused on inhaled vasodilatory treatment modalities which selectively target the pulmonary circulation.

Methods: We present a series of eight patients in whom inhaled iloprost, a synthetic prostacyclin analog, was used to treat pulmonary hypertension and right ventricular dysfunction detected by transesophageal echocardiography during a heart transplant procedure. In addition to conventional inotropic support, 20 mug of inhaled iloprost was administered via nebulized aerosol for a 20-min period. Complete sets of hemodynamic measurements were obtained before inhalation and during and after cessation of the inhalation period.

Results: Inhaled iloprost decreased the transpulmonary gradient at the end of the inhalation period relative to baseline (8.2 +/- 1.6 mmHg vs. 11.2 +/- 0.9 mmHg, P < 0.05). The mean pulmonary artery pressure to systemic artery pressure ratio decreased over this period (0.24 +/- 0.07 vs. 0.44 +/- 0.09, P < 0.05). A statistically significant decrease in the pulmonary vascular resistance to systemic vascular resistance ratio was also observed (0.10 +/- 0.02 vs. 0.19 +/- 0.02, P < 0.05). Improved indices of right ventricular function were observed in echocardiographic monitoring.

Conclusion: During heart transplantation procedures, episodes of pulmonary hypertension can be successfully treated with inhaled iloprost administration, without untoward side-effects or significant systemic impact.

Publication types

  • Clinical Trial

MeSH terms

  • Administration, Inhalation
  • Adult
  • Blood Pressure / drug effects
  • Cardiomyopathy, Dilated / surgery
  • Female
  • Heart Rate / drug effects
  • Heart Transplantation / methods*
  • Humans
  • Iloprost / administration & dosage*
  • Iloprost / therapeutic use*
  • Male
  • Middle Aged
  • Myocardial Ischemia
  • Vascular Resistance / drug effects
  • Vasodilator Agents / administration & dosage
  • Vasodilator Agents / therapeutic use
  • Ventricular Dysfunction, Right / complications
  • Ventricular Dysfunction, Right / drug therapy*


  • Vasodilator Agents
  • Iloprost