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Acute vasodilator testing following Fontan palliation: an opportunity to guide precision care?

Published online by Cambridge University Press:  22 May 2020

Ronald W. Day Open the ORCID record for Ronald W. Day [Opens in a new window]
Ronald W. Day*
Affiliation:
Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
*
Author for correspondence: Ronald W. Day, MD, Primary Children’s Hospital, 81 North Mario Capecchi Drive, Salt Lake City, UT84113, USA. Tel: +1 801 213 7635; Fax: +1 801 213 7778. E-mail: ronald.day@hsc.utah.edu
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Abstract

Background:

Pulmonary vasodilators improve the functional capacity of some patients with pulmonary arterial hypertension. However, pulmonary vasodilators frequently fail to improve unequivocal endpoints of efficacy in patients with lower pulmonary arterial pressures who have been palliated with a Fontan procedure.

Objective:

Haemodynamic measurements and the results of acute vasodilator testing in a subset of patients were reviewed to determine whether some patients acutely respond more favourably to sildenafil and might be candidates for precision care with a phosphodiesterase V inhibitor long term.

Materials and Methods:

Heart catheterisation was performed in 11 patients with a Fontan procedure. Haemodynamic measurements were performed before and after treatment with intravenous sildenafil (mean 0.14, range 0.05–0.20 mg/kg). Results (mean ± standard deviation) were compared by paired and unpaired t-tests to identify statistically significant changes.

Results:

Sildenafil was acutely associated with changes in mean pulmonary arterial pressure, transpulmonary gradient, indexed blood flow, and indexed vascular resistance. Changes in mean pulmonary arterial pressure were greater for patients with a mean pulmonary arterial pressure greater than 14 mmHg compared to patients with a lower mean pulmonary arterial pressure. Changes in transpulmonary gradient were greater for patients with a transpulmonary gradient greater than 5 mmHg compared to patients with a lower transpulmonary gradient.

Conclusion:

Sildenafil acutely decreases mean pulmonary arterial pressure and transpulmonary gradient and causes greater acute changes in patients with higher mean pulmonary arterial pressures and transpulmonary gradients. Haemodynamic measurements and vasodilator testing might help to guide precision care following Fontan palliation.

Keywords

Acute vasodilator testingFontan procedureheart catheterisationphosphodiesterase V inhibition
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 6 , June 2020 , pp. 829 - 833
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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