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Comparison of the therapeutic effects and side effects of tadalafil and sildenafil after surgery in young infants with pulmonary arterial hypertension due to systemic-to-pulmonary shunts

Published online by Cambridge University Press:  29 May 2017

Mohammad Reza Sabri ,
Hamid Bigdelian ,
Mohsen Hosseinzadeh ,
Alireza Ahmadi ,
Mehdi Ghaderian  and
Mohammad Shoja
Mohammad Reza Sabri
Affiliation:
Pediatric Department, Isfahan University of Medical Sciences, Isfahan, Iran Pediatric Cardiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan Iran
Hamid Bigdelian
Affiliation:
Pediatric Cardiac Surgery Department, Isfahan University of Medical Sciences, Isfahan Iran Pediatric Cardiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan Iran
Mohsen Hosseinzadeh*
Affiliation:
Pediatric Department, Isfahan University of Medical Sciences, Isfahan, Iran Pediatric Cardiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan Iran
Alireza Ahmadi
Affiliation:
Pediatric Department, Isfahan University of Medical Sciences, Isfahan, Iran Pediatric Cardiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan Iran
Mehdi Ghaderian
Affiliation:
Pediatric Department, Isfahan University of Medical Sciences, Isfahan, Iran Pediatric Cardiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan Iran
Mohammad Shoja
Affiliation:
Pediatric Department, Isfahan University of Medical Sciences, Isfahan, Iran
*
Correspondence to: M. Hosseinzadeh, Pediatric Department, Isfahan University of Medical Sciences, Isfahan, Iran. Tel: +983133868247 Fax: +983133868286 E-mail: [email protected]
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Abstract

Young children with CHD and large systemic-to-pulmonary shunts eventually develop pulmonary hypertension. At present, phosphodiesterase type-5 inhibitors such as sildenafil have been used to control pulmonary pressure before and after cardiac surgery. Recently, tadalafil has been utilised in older children with similar efficacy, but it has been used to a lesser extent in young infants. From April, 2015 to June, 2016, 42 patients aged 3–24 months with a large septal defect and pulmonary arterial hypertension were randomly divided into two equal groups: one group received oral sildenafil (1–3 mg/kg/day every 8 hours), whereas the other group received oral tadalafil (1 mg/kg once a day) from 7–10 days before surgery to 3–4 weeks after surgery. During the first 48 hours after surgery, pulmonary artery-to-aortic pressure ratio and recorded systolic pulmonary artery pressures were not significantly different between the two groups (p>0.05); moreover, there were no differences in paediatric ICU length of stay, mechanical ventilation time, clinical findings of low cardiac output state, and echocardiographic data between the two groups (p>0.05). Most of the patients had no side effects, and only five patients had a minor with no significant difference in both groups (p=0.371). Tadalafil can be considered as an effective oral therapy for preoperative and postoperative pulmonary hypertension in young infants. It can be administered at a once-daily dose with an appropriate efficacy and safety profile as sildenafil, and therefore it can be considered as an alternative to sildenafil in young children.

Keywords

Pulmonary arterial hypertensionCHDtadalafilsildenafilyoung children
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1686 - 1693
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Copyright
© Cambridge University Press 2017 

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References

1. Peiravian, F, Amirghofran, AA, Borzouee, M, Ajami, GH, Sabri, MR, Kolaee, S. Oral sildenafil to control pulmonary hypertension after congenital heart surgery. Asian Cardiovasc Thorac Ann 2007; 15: 113–117.CrossRefGoogle ScholarPubMed
2. Fraisse, A, Butrous, G, Taylor, MB, Oakes, M, Dilleen, M, Wessel, DL. Intravenous sildenafil for postoperative pulmonary hypertension in children with congenital heart disease. Intensive Care Medicine 2011; 37: 502–509.Google Scholar
3. Palma, G, Giordano, R, Russolillo, V, et al. Sildenafil therapy for pulmonary hypertension before and after pediatric congenital heart surgery. Tex Heart Inst J 2011; 38: 238.Google Scholar
4. Ivy, DD. Pediatric pulmonary hypertension. In: Allen HD, Shaddy RE, Penny DJ, Feltes TF and Cetta F (eds). Moss and Adams’ Heart Disease in Infants, Children, and Adolescents Including the Fetus and Young Adult. Wolters Kluwer, Philadelphia, 2016: 1519–1558.Google Scholar
5. Kirklin, JK, Barratt-Boyes. Postoperative care. In: Cardiac Surgery. Elsevier, Saunders, Philadelphia, PA, 2013: 211–212.Google Scholar
6. Takatsuki, S, Calderbank, M, Ivy, D. Initial experience with tadalafil in pediatric pulmonary arterial hypertension. Pediatr Cardiol 2012; 33: 683–688.CrossRefGoogle ScholarPubMed
7. Shiva, A, Shiran, M, Rafati, M, et al. Oral tadalafil in children with pulmonary arterial hypertension. Drug Res (Stuttg) 2016; 66: 7–10.Google Scholar
8. European Medicines Agency (http://www.ema.europa.eu).Google Scholar
9. US Department of Health and Human Services. UFa, communication: DAFds, children FrauoRsi and hypertension. wp. FDA recommends against use of Revatio (sildenafil) in children with pulmonary hypertension, 2012.Google Scholar
10. Sabri, MR, Beheshtian, E. Comparison of the therapeutic and side effects of tadalafil and sildenafil in children and adolescents with pulmonary arterial hypertension. Pediatr Cardiol 2014; 35: 699–704.Google Scholar
11. Atz, AM, Lefler, AK, Fairbrother, DL, Uber, WE, Bradley, SM. Sildenafil augments the effect of inhaled nitric oxide for postoperative pulmonary hypertensive crises. J Thorac Cardiovasc Surg 2002; 124: 628–629.Google Scholar
12. Klugman, D, Laussen, PC, Wessel, DL. Pediatric cardiac intensive care. In: Jonas RA, (ed.) Comprehensive Surgical Management of Congenital Heart Disease. Taylor & Francis Group, Boca Raton, London, New York, 2014: 37.Google Scholar
13. Sabri, MR, Zolfi-Gol, A, Ahmadi, A, Haghjooy-Javanmard, S. Effect of tadalafil on myocardial and endothelial function and exercise performance after modified Fontan operation. Pediatr Cardiol 2016; 37: 55–61.Google Scholar
14. Hoffman, TM, Wernovsky, G, Atz, AM, et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 2003; 107: 996–1002.Google Scholar
15. Ulate, KP, Yanay, O, Jeffries, H, Baden, H, Di Gennaro, JL, Zimmerman, J. An elevated low cardiac output syndrome score is associated with morbidity in infants after congenital heart surgery. Pediatr Crit Care Med 2017; 18: 26–33.Google Scholar
16. Jone, P-N, Ivy, DD. Echocardiography in pediatric pulmonary hypertension. Front Pediatr 2014: 2.Google Scholar