TY - JOUR
T1 - Reversibility of medically unresponsive pulmonary hypertension with nesiritide in a cardiac transplant recipient
AU - Bhat, Geetha
AU - Costea, Alex
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2003
Y1 - 2003
N2 - Pulmonary hypertension unresponsive to medical therapy is considered by most centers to be a contraindication for orthotopic cardiac transplantation. This article describes a patient with unresponsive severe pulmonary hypertension who, despite a combination of maximal doses of dobutamine, milrinone, and nitroprusside infusion, responded to nesiritide (Natrecor) infusion with improvement in pulmonary hemodynamics. The patient was considered a high risk for transplantation because of significant pulmonary hypertension in spite of maximum oral therapy and continuous intravenous milrinone. Severe irreversible pulmonary hypertension persisted with a combination of dobutamine, milrinone, and nitroprusside, with pulmonary artery pressure (PA) of 88/44 mm Hg, a transpulmonary gradient (TPG) of 27, and pulmonary vascular resistance (PVR) of 5.79 Wood units. Upon addition of nesiritide, within 24 hours, there was a sustained decrease in PA to 47/30, TPG of 15, and PVR of 3.75 Wood units. The patient underwent successful left ventricular assist device placement soon after nesiritide infusion demonstrated reversibility of pulmonary hypertension. He subsequently underwent uneventful orthotopic cardiac transplantation and has done well with normal right heart pressures. This case illustrates that addition of nesiritide to standard therapy can reverse significant unresponsive pulmonary hypertension and make a patient eligible for left ventricular assist device and orthotopic cardiac transplantation.
AB - Pulmonary hypertension unresponsive to medical therapy is considered by most centers to be a contraindication for orthotopic cardiac transplantation. This article describes a patient with unresponsive severe pulmonary hypertension who, despite a combination of maximal doses of dobutamine, milrinone, and nitroprusside infusion, responded to nesiritide (Natrecor) infusion with improvement in pulmonary hemodynamics. The patient was considered a high risk for transplantation because of significant pulmonary hypertension in spite of maximum oral therapy and continuous intravenous milrinone. Severe irreversible pulmonary hypertension persisted with a combination of dobutamine, milrinone, and nitroprusside, with pulmonary artery pressure (PA) of 88/44 mm Hg, a transpulmonary gradient (TPG) of 27, and pulmonary vascular resistance (PVR) of 5.79 Wood units. Upon addition of nesiritide, within 24 hours, there was a sustained decrease in PA to 47/30, TPG of 15, and PVR of 3.75 Wood units. The patient underwent successful left ventricular assist device placement soon after nesiritide infusion demonstrated reversibility of pulmonary hypertension. He subsequently underwent uneventful orthotopic cardiac transplantation and has done well with normal right heart pressures. This case illustrates that addition of nesiritide to standard therapy can reverse significant unresponsive pulmonary hypertension and make a patient eligible for left ventricular assist device and orthotopic cardiac transplantation.
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U2 - 10.1097/01.MAT.0000084110.31316.89
DO - 10.1097/01.MAT.0000084110.31316.89
M3 - Article
C2 - 14524574
AN - SCOPUS:0141702089
SN - 1058-2916
VL - 49
SP - 608
EP - 610
JO - ASAIO Journal
JF - ASAIO Journal
IS - 5
ER -