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Comparative efficacy of sildenafil in Eisenmenger's syndrome secondary to atrial septal defect versus ventricular septal defect: a cardiac catheterisation follow-up study

Published online by Cambridge University Press:  08 June 2011

Naveen Garg ,
Nishant Tripathy  and
Nakul Sinha
Naveen Garg*
Affiliation:
Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
Nishant Tripathy
Affiliation:
Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
Nakul Sinha
Affiliation:
Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
*
Correspondence to: Dr. N. Garg, Additional Professor, Department of Cardiology, Sanjay Gandhi PGIMS, Raibareli Road, Lucknow, India. Tel: 2668700; Extn: 2218; Fax: 91 0522 2668017; E-mail: navgarg@sgpgi.ac.in
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Abstract

Objectives

This study evaluates the efficacy and safety of sildenafil in patients with Eisenmenger's syndrome with special emphasis on haemodynamic parameters and its comparative efficacy in atrial septal defect versus ventricular septal defect patients.

Methods

Oral sildenafil was given to 22 patients with Eisenmenger's syndrome – eight with atrial septal defect and 14 with ventricular septal defect – after detailed baseline evaluation including a six-minute walk test, echocardiography, and cardiac catheterisation. Patients were followed up for a period of 6 months for functional class assessment and six-minute walk distance. Cardiac catheterisation was repeated in all patients.

Results

A significant improvement in the World Health Organization functional class, six-minute walk distance, mean pulmonary arterial pressure, and pulmonary vascular resistance was noticed. Systemic arterial and mixed venous oxygen saturations were also significantly improved along with improvement in pulmonary blood flow. None showed any significant side effects or worsening of systemic arterial saturation. At baseline, mean pulmonary arterial pressure, pulmonary vascular resistance, and pulmonary/systemic vascular resistance ratios were significantly higher in ventricular septal defect patients than in atrial septal defect patients. Atrial septal defect patients showed better response in clinical as well as haemodynamic parameters.

Conclusions

Sildenafil is an effective and safe agent for patients with Eisenmenger's syndrome. It improves their functional capacity as well as haemodynamic parameters. The beneficial effects are greater in patients with Eisenmenger's syndrome secondary to atrial septal defect than ventricular septal defect.

Keywords

Congenital cardiac diseasepulmonary arterial hypertensionphosphodiesterase inhibitor
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 6 , 28 October 2011 , pp. 631 - 638
Copyright
Copyright © Cambridge University Press 2011

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References

1.Waddell, TK, Bennett, L, Kennedy, R, Todd, TR, Keshavjee, SH. Heart-lung or lung transplantation for Eisenmenger syndrome. J Heart Lung Transplant 2002; 21: 731–737.CrossRefGoogle ScholarPubMed
2.Curran, WD, Akindipe, O, Staples, ED, Baz, MA. Lung transplantation for primary pulmonary hypertension and Eisenmenger's syndrome. J Cardiovasc Nurs 2005; 20: 124–132.CrossRefGoogle ScholarPubMed
3.Agapito, AF, Sousa, L, Oliveira, JA, et al. Eisenmenger syndrome in the adults- experience with new drugs for the treatment of pulmonary hypertension. Rev Port Cardiol 2005; 24: 421–431.Google ScholarPubMed
4.Mukhopadhyay, S, Sharma, M, Ramakrishnan, S, et al. Phosphodiesterase-5 inhibitor in Eisenmenger syndrome; a preliminary observational study. Circulation 2006; 114: 1807–1810.CrossRefGoogle ScholarPubMed
5.Lim, ZS, Salmon, AP, Vettukattil, JJ, et al. Sildenafil therapy for pulmonary arterial hypertension associated with atrial septal defects. Int J Cardiol 2007; 118: 178–182.CrossRefGoogle ScholarPubMed
6.Lacassie, HJ, Germain, AM, Valdes, G, et al. Management of Eisenmenger syndrome in pregnancy with sildenafil and L-arginine. Obstet Gynecol 2004; 103: 1118–1120.CrossRefGoogle ScholarPubMed
7.Okyay, K, Cemri, M, Boyact, B, et al. Use of long-term combined therapy with inhaled iloprost and oral sildenafil in an adult patient with Eisenmenger syndrome. Cardiol Rev 2005; 13: 312–314.CrossRefGoogle Scholar
8.Alto, MD, Vizza, CD, Romeo, E, et al. Long tern effects of bosentan treatment in adult patients with pulmonary arterial hypertension related to congenital heart disease (Eisenmenger physiology): safety, tolerability, clinical, and haemodynamic effect. Heart 2007; 93: 621–625.CrossRefGoogle Scholar
9.Adriaenssens, T, Delcroix, M, Van Deyk, K, et al. Advanced therapy may delay the need for transplantation in patients with the Eisenmenger syndrome. Eur Heart J 2006; 27: 1472–1477.CrossRefGoogle ScholarPubMed
10.Corbin, JD, Francis, SH. Cyclic GMP phosphodieserase-5: target of sildenafil. J Biol Chem 1999; 274: 13729–13732.CrossRefGoogle Scholar
11.Sastry, BKS, Narasimhan, C, Reddy, NK, et al. Clinicaly efficacy of sildenafil in primary pulmonary hypertension – a randomized, placebo controlled, double blind, crossover study. J Am Coll Cardiol 2004; 43: 1149–1153.CrossRefGoogle Scholar
12.Chockalingam, A, Gnanavelu, G, Venkatesan, S, et al. Efficacy and optimal dose of sildenafil in primary pulmonary hypertension. Int J Cardiol 2005; 99: 91–95.CrossRefGoogle ScholarPubMed
13.Kataoka, M, Satoh, T, Manabe, T, et al. Oral sildenafil improves primary pulmonary hypertension refractory to epoprostenol. Circ J 2005; 69: 461–465.CrossRefGoogle ScholarPubMed
14.Gupta, A, Kerkar, P. Sildenafil for pulmonary hypertension secondary to congenital heart diseases. Indian Heart J 2007; 59: 342–345.Google ScholarPubMed
15.Garg, N, Sharma, MK, Sinha, N. Role of sildenafil in severe pulmonary arterial hypertension: clinical efficacy and dose response relationship. Int J Cardiol 2007; 120: 306–313.CrossRefGoogle ScholarPubMed
16.Galie, N, Ghofrani, HA, Torbicki, A, et al. Sildenafil citrate therapy for pulmonary arterial hypertension. N Engl J Med 2005; 353: 2148–2157.CrossRefGoogle ScholarPubMed
17.Singh, TP, Rohit, M, Grover, A, et al. A randomized, placebo-controlled, double-blind, crossover study to evaluate the efficacy of oral sildenafil therapy in severe pulmonary arterial hypertension. Am Heart J 2006; 151: 851.e1–e5.CrossRefGoogle Scholar
18.Miyamoto, S, Nagaya, N, Satoh, T, et al. Clinical correlates and prognostic significance of six minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med 2000; 161: 487–492.CrossRefGoogle ScholarPubMed
19.Grossman, W. Blood Flow Measurement: Cardiac Output and Vascular Resistances. In: Baim DS (ed.). Grossman's Cardiac Catheterization, Angiography and Intervention, 7th edn. Lippincott Willium & Wilkins, Philadelphia, 2006, pp. 148–162.Google Scholar
20.Diller, GP, Gatzoulis, MA. Pulmonary vascular disease with congenital heart disease. Circulation 2007; 115: 1039–1050.CrossRefGoogle ScholarPubMed
21.Van Albada, ME, Berger, RM. Pulmonary arterial hypertension in congenital cardiac disease – the need for refinement of the Evian-Venice classification. Cardiol Young 2008; 18: 10–17.CrossRefGoogle ScholarPubMed
22.Berger, RM, Beghetti, M, Galie, N, et al. Atrial septal defects versus ventricular septal defects in BREATHE-5, a placebo-controlled study of pulmonary arterial hypertension related to Eisenmenger's syndrome: a subgroup analysis. Int J Cardiol 2010; 144: 373–378.CrossRefGoogle ScholarPubMed