Korean Circ J.  2009 Aug;39(8):343-345. 10.4070/kcj.2009.39.8.343.

Use of Inhaled Iloprost in an Infant With Bronchopulmonary Dysplasia and Pulmonary Artery Hypertension

• Hwang SK
• O YC
• Kim NS
• Park HK
• Yum MK

• KMID: 2225686
• DOI: http://doi.org/10.4070/kcj.2009.39.8.343

Abstract

Pulmonary artery hypertension is a common cardiovascular complication in preterm infants with bronchopulmonary dysplasia which is associated with increased morbidity and mortality. Inhaled iloprost is used as a therapeutic option in pulmonary hypertension, especially in adults. There have been but a few reports on the use of iloprost for neonates and infants. We report the case of a 5 month-old-male infant who received neonatal intensive care for 4 months due to respiratory distress syndrome and prematurity, during which he developed bronchopulmonary dysplasia. Echocardiography showed severe pulmonary hypertension. The initial treatment included respiratory support with high frequency oscillatory ventilation (HFOV); however, his clinical condition did not improve. Inhaled iloprost with sildenafil, an oral phosphodiesterase-5 inhibitor, was thus used. With the administration of iloprost and sildenafil, his condition improved and he was weaned from oxygen. Our clinical experience suggests that iloprost is a promising therapy for pulmonary hypertension, especially when inhaled nitric oxide is unavailable.

Keyword

Pulmonary hypertension; Bronchopulmonary dysplasia; Iloprost

MeSH Terms

Adult
Bronchopulmonary Dysplasia
Cyclic Nucleotide Phosphodiesterases, Type 5
Echocardiography
Humans
Hypertension
Hypertension, Pulmonary
Iloprost
Infant
Infant, Newborn
Infant, Premature
Intensive Care, Neonatal
Nitric Oxide
Oxygen
Piperazines
Pulmonary Artery
Purines
Sulfones
Ventilation
Sildenafil Citrate
Cyclic Nucleotide Phosphodiesterases, Type 5
Iloprost
Nitric Oxide
Oxygen
Piperazines
Purines
Sulfones

Figure

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  Fig. 1 Initial chest radiography showed severe cardiomegaly.

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  Fig. 2 Based on echocardiography, the pulmonary pressure was elevated, with a pressure gradient (TR PG) of 48 mmHg (A) and there was a severely dilated right ventricle (RV) with tricuspid valve regurgitation (B).

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  Fig. 3 Chest radiography showed improvement in cardiomegaly on follow-up after 2 months later.

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  Fig. 4 The inhaled iloprost increased the oxygenation (saturation >95%). Serial echocardiograms showed mild elevated pulmonary pressure, with a TR PG of 34 mmHg (A) and a decrease in the size of the RV (B). RV: right ventricle.

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