- Case report
- Open Access
Acute hemodynamic effect of inhaled iloprost in pulmonary artery hypertension evaluated with echocardiography
Cardiovascular Ultrasound volume 5, Article number: 41 (2007)
Doppler echocardiography is useful in the initial evaluation and long-term follow-up of patients with pulmonary artery hypertension. Aerosolised iloprost has been shown to reduce pulmonary pressure immediately after inhalation. We report the echocardiographic findings in a patient with severe pulmonary hypertension, before and after the inhalation of aerosolized iloprost. These findings illustrate the acute influence of iloprost in right and left ventricular hemodynamics and morphology. These findings were reproduced in subsequent echocardiographic evaluations.
A 21-year-old woman diagnosed with idiopathic pulmonary hypertension since she was eleven, responsive to calcium channel blockers, was referred for Cardiology consultation at 23 weeks pregnancy. She was on nifedipine and fraxiparine and Doppler echocardiography revealed a dilated and hypertrophied right ventricle and a peak tricuspid regurgitant jet velocity of 5.3 ms-1 with estimated right ventricular systolic pressure (RVSP) of 122 mmHg. She was then started on 5.0 μg of nebulized iloprost six times per day. At the 29th week of pregnancy Doppler echocardiography was repeated before and immediately after a single dose of 5 μg of iloprost. Postinhalation acute assessment revealed not only a remarkable reduction in RVSP but also an impressive change in cardiac morphology as is evident from figures 1, 2 and 3 and from two-dimensional and three-dimensional echocardiography video clips (see Additional files 1, 2, 3 and 4). These findings were reproduced in subsequent echocardiographic evaluations and illustrate the acute hemodynamic effects of iloprost nebulization in a patient with severe pulmonary hypertension.
The findings that we describe showed the potential utility of echocardiography in the evaluation of the acute effects of drugs used in the treatment of pulmonary arterial hypertension.
Bossone E, Bodini B, Mazza A, Allegra L: Pulmonary arterial hypertension. The key role of echocardiography. Chest. 2005, 127: 1836-1843. 10.1378/chest.127.5.1836.
Burgess M, Bright-Thomas R, Ray S: Echocardiographic evaluation of right ventricular function. Eur J Echocardiography. 2002, 3: 252-262.
Written informed consent was obtained for publication from the patient.
Electronic supplementary material
Additional file 1: Two-dimensional parasternal view before iloprost inhalation. Two-dimensional parasternal long and short axis views before iloprost inhalation showing a small left ventricle with increased eccentricity index. (AVI 4 MB)
Additional file 2: Two-dimensional parasternal view after iloprost inhalation. Two-dimensional parasternal long and short axis views after iloprost inhalation showing near normal morphology of both ventricles. (AVI 5 MB)
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Loureiro, M.J., Cotrim, C., Simões, O. et al. Acute hemodynamic effect of inhaled iloprost in pulmonary artery hypertension evaluated with echocardiography. Cardiovasc Ultrasound 5, 41 (2007). https://doi.org/10.1186/1476-7120-5-41
- Pulmonary Arterial Hypertension
- Doppler Echocardiography
- Pulmonary Artery Hypertension
- Severe Pulmonary Hypertension