[A case of pulmonary hypertensive crisis (PHC) treated with prostaglandin E1 and tolazolin after surgery of ventricular septal defect in an adult]

Abstract

A 32-year-old woman was diagnosed with ventricular septal defect (VSD) with severe pulmonary hypertension (PH). Though Pp/Ps was 0.98, an operation was carried out because the index of pulmonary vascular disease (IPVD) was 1.73. Pp/Ps on the operation day was 0.51 and extubation was carried out on the next day. Five days after the operation, she suffered shock, convulsions and loss of consciousness, but these were relieved by endotracheal intubation. On the 7th day, because Pp/Ps was 0.97, we confirmed the diagnosis of PHC. PHC was treated by intravenous continuous infusion of a high dose of PGE1 (220 ng/kg/min) and tolazolin (Tz) (7-18 micrograms/kg/min) in combination with norepinephrine (0.07 microgram/kg/min) via a catheter in the descending aorta. Pp/Ps soon decreased and was 0.60 at 15 hours after administration of PGE1 and Tz. To prevent recurrent PHC, she was administered with PGE1 (20-60 ng/kg/min) intravenously for 3 weeks after improvement of PHC. As side effects of PGE1, she showed swelling and arthralgia of the hands and feet after 2 weeks. Those side effects improved after discontinuing of administration of PGE1.