The infusion of
prostaglandin E1, a vasodilating substance with predominant effects on the pulmonary vasculature, has been found effective in the management of
pulmonary hypertension associated with various diseases. The reported experience with
prostaglandin E1 after
cardiac transplantation is, however, limited. We used
prostaglandin E1 in 18 patients in whom acute right ventricular failure developed after orthotopic
cardiac transplantation. The infusion was started within 24 hours after operation in 16 patients and was continued for up to 7 days. Maximal doses of
prostaglandin E1, administered via a
central venous catheter, ranged from 30 to 120 ng/kg/min.
Norepinephrine was simultaneously infused via a left atrial
catheter in 10 patients to prevent a reduction in systemic arterial pressure. The
prostaglandin E1 infusion resulted in significant reductions in mean arterial pressure and pulmonary vascular resistance and simultaneous increases in cardiac index and
stroke index. Mean arterial pressure was stable and left ventricular
stroke work increased. The alveolar
oxygen tension/forced inspiratory
oxygen index tended to decrease during the infusion. Three patients died, two of right
heart failure and one of
multiple organ failure associated with cardiac allograft rejection. In patients in whom right ventricular failure associated with
pulmonary hypertension develops after
cardiac transplantation,
prostaglandin E1, combined with
norepinephrine whenever the arterial pressure declines, can effectively reduce pulmonary artery pressures and improve global cardiac function without compromising systemic perfusion.