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Particularly for the left ventricular assist device patients, though it should be noted that these patients did not require return trips to the operating room for right ventricular assist devices, and

• Sildenafil is available by prescription only in most countries.
• The medication comes in various dosages, typically 25mg, 50mg, and 100mg.
• Adjust dosage as directed by your healthcare provider.

that is a significant outcome, but we don't have enough numbers or data to make a firm projection on whether or not this really affects the clinical outcomes of the patients.

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Because experience with sildenafil and postoperative pulmonary hypertension is limited, the optimal dose has not been established. Initial doses were similar to that described in previous case reports, with intervals determined by observation of pulmonary hemodynamics. Preexisting pulmonary hypertension and postoperative acute pulmonary hypertension complicate the management of patients with mitral valve disease. Our experience showed that in six different patients undergoing mitral valve surgery, PAP and PVR decreased following sildenafil administration. Furthermore, conventional therapies for pulmonary hypertension were successfully weaned with no rebound pulmonary hypertension.

Clinics in Endocrinology and Metabolism

Severe pulmonary hypertension can also lead to right ventricular failure in patients with LVADs. In order to assure delivery of preload to the LVAD, right ventricular function must be preserved. Sildenafil reduced pulmonary hypertension in both our patients with LVADs, improving LVAD filling and obviating the need for RVAD placement. Consequently sildenafil 130mg both LVAD patients progressed to heart transplantation without difficulty. The ability of PDE-V inhibitors, including sildenafil, zaprinast, and dipyridamole to decrease MPAP and PVR has been previously demonstrated in experimental models of pulmonary hypertension [11–14].

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Their effectiveness correlates with the level of PDE-V inhibition and the increase in pulmonary vascular smooth muscle cGMP [15]. This report has significant limitations, as it is a retrospective review of a small number of patients with no controls. However, the findings are consistent with the few isolated case reports describing the use of PDE-V inhibitors as pulmonary vasodilators in patients undergoing cardiac surgery. Intravenous dipyridamole was used successfully in a small series of pediatric heart surgery patients [16]. However, dipyridamole has antiplatelet effects that are undesirable in the perioperative period. Inhaled nitric oxide: therapeutic application in cardiothoracic surgery Sildenafil is a pulmonary vasodilator in awake lambs with acute pulmonary hypertension Effect of sildenafil on the acute pulmonary vasodilator response to inhaled nitric

• Always consult a healthcare provider before starting sildenafil.
• Do not exceed the prescribed dose to avoid side effects.
• Sildenafil can interact with nitrates, causing dangerous blood pressure drops.

oxide in adults with pulmonary hypertension Sildenafil for treatment of lung fibrosis and pulmonary hypertension: a randomised controlled trial Combination therapy with oral sildenafil and inhaled iloprost for severe pulmonary hypertension Bonnell, M. ∙ Urdaneta, F.

Condition	Caution / Notes	Risk Factors
Cardiovascular disease	Use with caution	Heart failure, recent MI
Concomitant nitrate use	Absolute contraindication	Risk of severe hypotension
Severe hepatic impairment	May require dose adjustment	Reduced clearance
Retinitis Pigmentosa	Cautious use	Potential for vision disturbances

∙ Kirby, D.S...

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Effects of UK 343–644 on a porcine model of acute pulmonary hypertension Sildenafil as a selective pulmonary vasodilator in childhood primary pulmonary hypertension Long-term treatment with oral

Parameter	Description	Typical Value	Notes
Absorption Rate	How quickly sildenafil enters bloodstream	Rapid	Peaks in 30-120 minutes
Bioavailability	Percentage of dose reaching systemic circulation	~40%	Affected by food intake
Half-life	Time for plasma concentration to reduce by half	3-5 hours	Determines dosing frequency
Peak Plasma Concentration	Maximum concentration after dose	1 hour	Influenced by gastric emptying and food intake

sildenafil in addition to continuous IV epoprostenol in patients with pulmonary arterial hypertension Nebulized sildenafil is a selective pulmonary vasodilator in lambs with acute pulmonary hypertension Kieler-Jensen, N.

What should I know about storage and disposal of this medication?

In addition, withdrawal of inhaled NO therapy can lead to dangerous rebound pulmonary hypertension. Oral sildenafil, a phosphodiesterase type V (PDE-V) inhibitor, prevents the degradation of cGMP and has been shown to be as effective as inhaled NO in the setting of primary pulmonary hypertension and pulmonary fibrosis. However, sildenafil does not require an inhaled delivery system and does not cause rebound pulmonary hypertension [2–4]. Furthermore, its effects have been noted to last for at least three hours without affecting systemic arterial pressure [5]. In the laboratory we have demonstrated an intravenous formulation of a sildenafil analogue, UK 343 to 664, shows sustained reduction of pulmonary hypertension in a porcine model of pulmonary hypertension [6].

Recreational use

Increasing evidence has shown that sildenafil is an effective pulmonary vasodilator for both children and adults with primary pulmonary hypertension [7–10]. We report our initial experience with the use of sildenafil as adjunctive therapy for the postoperative pulmonary hypertension following cardiac surgery. After Institutional Review Board approval, we conducted a retrospective review of the initial eight consecutive patients that received sildenafil to treat persistent pulmonary hypertension after mitral valve surgery (n = 6) or left ventricular assist device (LVAD) placement (n = 2) at our institution. In each case, sildenafil was administered only if the patient had persistently elevated pulmonary artery pressures despite multiple, conventional pulmonary vasodilators (Table 1). Oral sildenafil was initiated in an intensive care setting, hemodynamics were closely monitored, and the dose was readministered based on pulmonary hemodynamics.

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Conventional agents were typically weaned 24 hours after administration of the first dose of sildenafil. The dose of sildenafil was recorded along with the hemodynamic factors. Pulmonary artery and systemic arterial vascular resistance indices were calculated according to standard formulas: PVRI = MPAP − LAP/CI and SVRI = MAP − CVP/CI, where PVRI = Pulmonary vascular resistance index MAP = mean arterial pressure, CVP = central venous pressure, MPAP = mean PAP, LAP = left atrial pressure, CI = cardiac index, and SVRI = systemic vascular resistance index. Hemodynamic measurements were recorded before the administration of the initial dose of sildenafil and 30 and 60 minutes later. Statistical analysis was performed with SAS software (Cary, NC) using analysis of variance with repeated measures. ∙ Lundin, S.

Material and Methods

Anecdotal reports of oral sildenafil in cardiac surgery patients include both the successful pulmonary vasodilation in a child with mitral stenosis and in an adult patient who underwent placement of a biventricular assist device [17, 18]. While lack of an intravenous formulation for sildenafil may limit its use in the early postoperative period; the availability of an effective, oral selective pulmonary vasodilator facilitates later postoperative management. In summary, this initial experience suggests that oral sildenafil can be an effective agent as part of a multimodal approach to postoperative pulmonary hypertension. Further studies are necessary to more clearly define the optimal dosing and role of sildenafil in patients following cardiac surgery. Special thanks to Esperanzo Olivo for her expert editorial and formatting assistance and to Diane Strong for coordinating the manuscript submission.

British Journal of Urology

How did you deal with the tumescence using Viagra on these patients? DR TRACHTE: We did not note tumescence, nor did our nurses examine for that, but we did notice some increased sexual drive in some of our patients as anecdotal reports. DR ROBERT B. LEE (Jackson, MI): I appreciate your presentation. I would assume that at least some of these patients were known to have pulmonary hypertension prior to operation. ∙ Ricksten, S.E.

What should I do if I forget a dose?

Have you looked at using it prophylactically to decrease their pulmonary hypertension 24 to 48 hours preoperatively and what would be your recommendation in that regard? DR TRACHTE: That is an excellent question. Our anesthesia attendings that are interested in Viagra are especially interested in this concept. We did have patients who did have preoperative pulmonary hypertension. In fact, one of the eight patients mentioned was on intravenous milrinone prior to reoperation. Vasodilator therapy after heart transplantation: effects of inhaled nitric oxide and intravenous prostacyclin prostaglandin E1 and SNP The cGMP phosphodiesterase inhibitor zaprinast enhances the effect of nitric oxide Sildenafil is a pulmonary vasodilator in

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awake lambs with acute pulmonary hypertension Effects of dipyridamole and inhaled nitric oxide in pediatric patients with

Why is this medication prescribed?

A p value less than 0.05 was considered significant. This review includes five males and three females. The mean age was 52 ± 10 years. The initial dose of sildenafil was based on surgeon preference and ranged between 25 and 50 mg. The same individual dose was repeated at regular intervals based on the tendency of pulmonary hemodynamics to return to baseline.

Cessation and Adverse Effects of Treatment

Table 1 shows the patients' demographics and the dose regimen for sildenafil. Following the administration of sildenafil, MPAP decreased by 9 mm Hg at 30 and 60 minutes (p < 0.05) (Table 2). A relative high degree of pulmonary selectivity was observed. Although a statistically significant difference in MAP was identified; it was not clinically significant (Fig 1). While systemic vascular index was not significantly different after sildenafil at 60 minutes, a marked decrease in PVRI was observed at both 30 and 60 minutes (Fig 2).

International Journal of Impotence Research

Other concomitant pulmonary vasodilators were weaned while sildenafil administration continued. There were no in-hospital mortalities among the eight patients. This retrospective review suggests that sildenafil produces marked pulmonary vasodilation when added to a preexisting regimen of nitrosovasodilators in patients with pulmonary hypertension following cardiac surgery. The pulmonary hypertension in this series of patients was refractory to conventional pharmacologic agents and was reduced on average by 20% with sildenafil. Sildenafil not only provided an additive pulmonary vasodilatory effect, but also allowed the successful weaning of inhaled and intravenous pulmonary vasodilators. pulmonary hypertension Sildenafil augments the effect of inhaled nitric oxide for postoperative pulmonary hypertensive crises Mychaskiw, G.

Overdose/Missed Dose

We have not used it preoperatively, but they have talked of trying to use that and are attempting to study that, and that is a very good question. DR JOHN H. CALHOON (San Antonio, TX): This is a very nice paper. My question would be what benefit do you think there is in simply affecting the pulmonary artery pressure and the pulmonary vascular resistance when you didn't make any change in the cardiac output? When you look at our patients, we looked at the hemodynamic data and found that there were no changes.