•  
  •  
 

Article Type

Original Study

Abstract

Introduction Pulmonary arterial hypertension (PH) is commonly found in patients with mitral valve diseases. Most of the drugs used for PH treatment are nonselective pulmonary vasodilators that may cause a modest decrease in pulmonary arterial pressure, but they may cause a marked decrease in systemic vascular resistance as well, which leads to hypotension and a decrease in perfusion of vital organs. Inhaled drugs such as milrinone and nitroglycerine may be safer as a large dose of the drug can selectively target the pulmonary circulation, which leads to a reduction of their systemic adverse effects. Aim This double-blind, randomized study compared milrinone inhalation versus nitroglycerin inhalation on pulmonary artery pressure and other hemodynamics in postoperative patients immediately after mitral valve replacement surgery. Patients and methods A total of 40 participants with isolated mitral stenosis or isolated mitral incompetence or their combination plus PH [mean pulmonary artery pressure (mPAP) >40 mmHg] scheduled for mitral valve replacement were interviewed. Immediately postoperatively in the ICU, we randomized the patients into two groups, with 20 patients each. Group A consisted of 20 patients who received milrinone inhalation, whereas group B consisted of 20 patients who received nitroglycerine inhalation. Hemodynamic parameters (heart rate, systolic blood pressure, diastolic blood pressure, mean blood pressure, central venous pressure, pulmonary artery systolic pressure, pulmonary diastolic pressure, mPAP, fractional shortening, ejection fraction, and pressure of oxygen/fraction of inspired oxygen ratio) were recorded in both groups at three time points: T1, before drug delivery; T2, just after drug delivery; and T3, just before extubation. Results The study showed that both milrinone and nitroglycerin inhalation caused a marked reduction in systolic, diastolic, and mPAPs without causing any hemodynamic deterioration effects on systolic, diastolic, or mean arterial pressures. Conclusion Although both milrinone and nitroglycerin inhalation proved to be effective pulmonary artery vasodilators that avoided systemic adverse effects, nitroglycerin inhalation is a less expensive, easily obtained drug that can serve as an inhaled pulmonary vasodilator in patients with mitral valve diseases and PH following mitral valve replacement surgeries.

Keywords

Milrinone inhalation, mitral valve replacement, mitral valve surgery, nitroglycerine inhalation, pulmonary hypertension

Download

Share

COinS