Case Reports Prostacyclin Usage in Treatment of Acute Right Heart Failure During Mitral Valve Replacement

In three patients with pulmonary hypertension (mean pulmonary artery pressure was 91±4.5/52±9.6 mmHg) acute right heart failure developed after mitral valve replacement. Because weaning from cardiopulmonary bypass was unsuccessful despite various medical and mechanical (intraaortic balloon) supports used, prostacyclin (Flolan, 5-20 nanogram/kg/min) was begun intravenously. We observed improvement of right ventricular contraction and decrease of mean pulmonary artery pressures to 52±2/29±6.2 mmHg (p<0.05) associated with decrease of mean pulmonary vascular resistance to 62±6 from 340±28 dyn.sec./cm5 (p<0.05) within first 30 minutes after prostacylin administration. Then,all patients were weaned from cardiopulmonary bypass. A complication related to prostacyclin was not detected. We concluded that combination of prostacyclin with inotropic drugs is an effective therapy to improve the detoriated hemodynamics of these patients.