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Inhaled Vasodilators in Right Heart Failure

  • Mahsa Elmi-Sarabi
  • André Denault
Chapter

Abstract

This chapter presents a brief description for the use of inhaled vasodilators in the management of right ventricular failure (RVF) in cardiac surgical patients. The effects of inhaled vasodilators extend beyond the right heart and pulmonary circulation and can also be seen on the portal vein and on cerebral oxygenation. Agents such as milrinone and epoprostenol, which are typically administered intravenously, can exert a more localized effect when aerosolized. In this form, these drugs can selectively lower pulmonary pressures without exhibiting a systemic effect, thus showing to be beneficial in the management of right ventricular (RV) dysfunction.

The experiences described in this chapter originate from researchers at the Montreal Heart Institute (MHI) in Quebec, Canada. The MHI is an ultraspecialized hospital centre dedicated to care, research, teaching, prevention, rehabilitation, and the assessment of new technologies in cardiology. It is affiliated with Université de Montréal.

Keywords

Inhaled vasodilator Milrinone Epoprostenol Pulmonary hypertension Cardiac surgery Near-infrared spectroscopy Portal vein pulsatility 

Abbreviations

CABG

Coronary artery bypass grafting

cAMP

Cyclic adenosine monophosphate

cGMP

Cyclic guanosine monophosphate

CO2

Carbon dioxide

CPB

Cardiopulmonary bypass

ET-1

Endothelin-1

ICU

Intensive care unit

LV

Left ventricular

MHI

Montreal Heart Institute

MPAP

Mean pulmonary artery pressure

NIRS

Near-infrared spectroscopy

NO

Nitric oxide

OR

Operating room

PAP

Pulmonary artery pressure

PDE

Phosphodiesterase

PDE-3

Phosphodiesterase type 3

PDE-5

Phosphodiesterase type 5

PGI2

Prostacyclin

PH

Pulmonary hypertension

Prv

Right ventricular pressure

RA

Right atrial

rSO2

Regional oxygen saturation

RV

Right ventricle

RVF

Right ventricular failure

TEE

Transesophageal echocardiography

TTE

Transthoracic echocardiography

TXA2

Thromboxane A2

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyMontreal Heart Institute, Université de MontréalMontrealCanada

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