الفهرس 
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Abstract
Pulmonary hypertension in pediatric patients with left to right shunts remains one of the most important determinants of perioperative morbidity and mortality. Sildenafil is an orally active inhibitor of PDE-5, inducing vasodilation and exhibiting antiproliferative effects through the NO/cyclic guanosine monophosphate pathway within the pulmonary vasculature. In 2011, sildenafil received EMA approval for use in children >1 year of age.
Tadalafil, an oral, selective PDE-5 inhibitor with a longer duration of action than sildenafil, was FDA-approved for use in adults with PAH in 2009. Although there is no published RCT data on the use of tadalafil in pediatric PAH, tadalafil started to be utilized in older children with similar efficacy in the era of FDA warning against the (chronic) use of sildenafil in children with PAH between 1 and 17 years of age in 2013, which was clarified in 2014 (“no contraindication” for pediatric use of sildenafil, but it has been used to a lesser extent in young infants.
For more than 2 years, 75 patients complaining of ASD, VSD, PDA or mixed shunts with moderate to severe pulmonary hypertension randomly enrolled in to 3 group control, sildenafil and tadalafil group (25 patients for each) to compare the efficacy of PDE-5 inhibitors in management of pulmonary hypertension after corrective surgeries.
Based on the American Society of Echocardiography guidelines, we used 2D doppler echocardiography as a non-invasive gold standard tool for measuring pulmonary artery pressure.
In our study, we compared the day 7 and the follow up echocardiographic measurements after 3 months in all groups with pre-operative measurements, we found that ERVSP and mPAP measurements improved in sildenafil and tadalafil groups as occurred in control group and this means that PDE-5 inhibitors did not influence neither the early post-operative pulmonary pressure readings nor the follow up ones and so, PDE-5 inhibitors did not affect the clinical course of those patients.
Also, we noticed that there was no significant difference in mechanical ventilation time, pulmonary hypertensive crisis or ICU stay between 3 groups.
Beside Our main study goal, we also noticed that RV function showed marked impairment in the early post- operative period with marked improvement in the follow up results after 3 months. Right heart tissue Doppler parameters pointed toward significant subclinical RV systolic and diastolic dysfunction after-cardiopulmonary bypass with preserved LV function.