Improvement in pulmonary hemodynamics during intravenous epoprostenol (prostacyclin): A study of 15 patients with moderate to severe portopulmonary hypertension

Michael Joseph Krowka, Robert Frantz, Michael D. Mcgoon, Cathy Severson, David J. Plevak, Russell H. Wiesner

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Abstract

Pulmonary hypertension associated with increased pulmonary vascular resistance (PVR) and occurring in the setting of portal hypertension is referred to as 'portopulmonary hypertension.' Intravenous epoprostenol (prostacyclin) is a potent pulmonary and systemic vasodilator with antithrombotic properties. It can decrease PVR and pulmonary artery pressure in patients with primary (idiopathic)pulmonary hypertension. Using right- heart catheterization, we evaluated the acute pulmonary hemodynamic effects of intravenous epoprostenol in patients with moderate to severe pulmonary hypertension (mean pulmonary artery pressure [MPAP] ≥35 mm Hg) associated with clinical manifestations of portal hypertension. Effects of long-term infusion of epoprostenol were also evaluated. We studied 15 consecutive patients with portopulmonary hypertension; 14 underwent acute administration of epoprostenol, and no significant side effects were noted. Ten patients received continuous epoprostenol (range, 8 days-30 months). Acute changes in PVR (-34% ± 18%), MPAP (-16% ± 10%), and cardiac output (CO) (+21 ± 18%), were statistically significant (P < .01). Long-term use of epoprostenol further lowered PVR (-47% ± 12% from baseline and -31% ± 22% from the acute change; P < .05) in the 6 patients restudied by right-heart catheterization. Death occurred in 6 of 10 (60%) of those receiving long-term epoprostenol. In moderate to severe portopulmonary hypertension, intravenous epoprostenol resulted in a significant improvement (both acute and long-term) in PVR, MPAP, and CO. Potential adverse effects on portal hypertension and implications for orthotopic liver transplantation (OLT), however, require further study.

Original languageEnglish (US)
Pages (from-to)641-648
Number of pages8
JournalHepatology
Volume30
Issue number3
DOIs
StatePublished - 1999

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Epoprostenol
Hemodynamics
Hypertension
Lung
Vascular Resistance
Pulmonary Artery
Portal Hypertension
Pressure
Cardiac Catheterization
Pulmonary Hypertension
Cardiac Output
Patient Rights
Vasodilator Agents
Liver Transplantation

ASJC Scopus subject areas

  • Hepatology

Cite this

Improvement in pulmonary hemodynamics during intravenous epoprostenol (prostacyclin) : A study of 15 patients with moderate to severe portopulmonary hypertension. / Krowka, Michael Joseph; Frantz, Robert; Mcgoon, Michael D.; Severson, Cathy; Plevak, David J.; Wiesner, Russell H.

In: Hepatology, Vol. 30, No. 3, 1999, p. 641-648.

Research output: Contribution to journalArticle

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abstract = "Pulmonary hypertension associated with increased pulmonary vascular resistance (PVR) and occurring in the setting of portal hypertension is referred to as 'portopulmonary hypertension.' Intravenous epoprostenol (prostacyclin) is a potent pulmonary and systemic vasodilator with antithrombotic properties. It can decrease PVR and pulmonary artery pressure in patients with primary (idiopathic)pulmonary hypertension. Using right- heart catheterization, we evaluated the acute pulmonary hemodynamic effects of intravenous epoprostenol in patients with moderate to severe pulmonary hypertension (mean pulmonary artery pressure [MPAP] ≥35 mm Hg) associated with clinical manifestations of portal hypertension. Effects of long-term infusion of epoprostenol were also evaluated. We studied 15 consecutive patients with portopulmonary hypertension; 14 underwent acute administration of epoprostenol, and no significant side effects were noted. Ten patients received continuous epoprostenol (range, 8 days-30 months). Acute changes in PVR (-34{\%} ± 18{\%}), MPAP (-16{\%} ± 10{\%}), and cardiac output (CO) (+21 ± 18{\%}), were statistically significant (P < .01). Long-term use of epoprostenol further lowered PVR (-47{\%} ± 12{\%} from baseline and -31{\%} ± 22{\%} from the acute change; P < .05) in the 6 patients restudied by right-heart catheterization. Death occurred in 6 of 10 (60{\%}) of those receiving long-term epoprostenol. In moderate to severe portopulmonary hypertension, intravenous epoprostenol resulted in a significant improvement (both acute and long-term) in PVR, MPAP, and CO. Potential adverse effects on portal hypertension and implications for orthotopic liver transplantation (OLT), however, require further study.",
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