الفهرس 
Transcatheter Device Closure of VSDsOnly 14 pages are availabe for public view
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Abstract
In spite the great improvement in the intensive care management
for cases of left to right shunt with pulmonary hypertension and
understanding a lot about pathophysiology of pulmonary hypertension
and the use of recent medications and methods to prevent and treat its
hazards, it still has less satisfactory outcome after closure in comparison
to cases with lower pulmonary artery pressure.
In this study we evaluated the effect of usage of pulmonary
antihypertensive drugs on the pulmonary artery pressure after surgical
closure of VSD. To detect the effect of pulmonary antihypertensive
drugs, we divided our patients into 2 groups. The first group included 60
patients who received only the anti-failure drugs and the second group
included 60 patients who received the same drugs in addition to selective
pulmonary vasodilators.
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. [95]
Tadalafil, an oral, selective PDE-5 inhibitor with a longer duration
of action than sildenafil, was FDA-approved for use in adults with PAH
Summary
82
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. [96]
All patients were subjected to pre, intra and postoperative studies
with follow up visit after 3 months. Correlations between the
preoperative, operative and postoperative data were presented with
concentration on the effect of pulmonary antihypertensive drugs on
postoperative pulmonary artery pressure.
In our study, patients who received selective pulmonary
vasodilators showed marked decrease in pulmonary pressure, ventilation
time, ICU stay and hospital stay. The incidence of pulmonary
hypertensive crises and mortality was also lower in patients who received
these drugs but without statistical significance.