Comparison of Acute Hemodynamic Effects of Aerosolized Iloprost and Inhaled Nitric Oxide in Adult Congenital Heart Disease with Severe Pulmonary Arterial Hypertension

Objective To compare the acute hemodynamic effects of aerosolized iloprost and inhaled nitric oxide (NO) in adult congenital heart disease (CHD) patients with severe pulmonary arterial hypertension (PAH). Methods One hundred and eighty five adult CHDs with severe PAH were nonrandomized into two groups (iloprost, n=127; NO, n=58). Various hemodynamic parameters were measured before and after iloprost or NO inhalation. Results Iloprost and NO inhalation resulted in significant reductions in pulmonary arterial pressure (from 110.6+/-21.8 mmHg to 105.5+/-22.3 mmHg, p<0.05; from 113.1+/-18.7 mmHg to 107.2+/-19.9 mmHg, p<0.05, respectively) and pulmonary vascular resistance (PVR) (from 13.4+/-8.3 Wood units to 9.6+/-6.4 Wood units, p<0.01; from 13.7+/-7.1 Wood units to 9.3+/-4.9 Wood units, p<0.01, respectively) and increases in pulmonary blood flow (from 6.7+/-3.3 L/min to 9.4+/-5.8 L/min, p<0.05; from 6.6+/-3.1 L/min to 9.6+/-5.9 L/min, p<0.01, respectively) and the Qp/Qs ratio (from 1.5+/-0.8 to 2.1+/-1.4, p<0.01; from 1.5+/-0.8 to 2.0+/-1.3, p<0.01, respectively). When the effects of inhaled iloprost and NO were compared, similar reductions in pulmonary arterial pressure and pulmonary vascular resistance were observed. Aerosolized iloprost and inhaled nitric oxide (iNO) were generally well tolerated and no patient experienced any side effects during inhalation. Conclusion Aerosolized iloprost can be effectively and safely used and might be an alternative to NO for testing pulmonary vascular reactivity and treating severe PAH in adult CHD patients.