Acute venodilation properties of low-dose intravenous nitroglycerine in pulmonary veno-occlusive disease: a case report.
Case report
Nitroglycerine
Pulmonary veno-occlusive disease
Venodilation
Journal
European heart journal. Case reports
ISSN: 2514-2119
Titre abrégé: Eur Heart J Case Rep
Pays: England
ID NLM: 101730741
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
29
06
2022
revised:
23
06
2023
accepted:
31
07
2023
medline:
14
8
2023
pubmed:
14
8
2023
entrez:
14
8
2023
Statut:
epublish
Résumé
The use of pulmonary vasodilators for pulmonary arterial hypertension (PAH) has led to a favourable prognosis. In contrast, pulmonary veno-occlusive disease (PVOD) is characterized by the possibility of severe pulmonary oedema after specific PAH therapy. Pulmonary oedema presumably develops in association with pulmonary arterial vasodilation without concomitant pulmonary venodilation. The venous circulation maximally dilates with small amounts of nitroglycerine. A 59-year-old woman with advanced PVOD was referred to our hospital. We performed a right heart catheterization after administering combination therapy with selexipag and macitentan, and intravenous nitroglycerine at 0.2 and 0.4 μg/kg/min decreased pulmonary arterial wedge pressure (PAWP) and mean pulmonary arterial pressure (PAP) to minimal levels. The final dose of 1 μg/kg/min yielded an ∼20% decrease in mean PAP and pulmonary vascular resistance (PVR). Here, we described the acute effect of intravenous nitroglycerine on PAWP and PVR in a patient with PVOD. This case highlights the venodilation response even in advanced PVOD, suggesting the importance of further research into selective venous dilators as potent therapy.
Sections du résumé
Background
UNASSIGNED
The use of pulmonary vasodilators for pulmonary arterial hypertension (PAH) has led to a favourable prognosis. In contrast, pulmonary veno-occlusive disease (PVOD) is characterized by the possibility of severe pulmonary oedema after specific PAH therapy. Pulmonary oedema presumably develops in association with pulmonary arterial vasodilation without concomitant pulmonary venodilation. The venous circulation maximally dilates with small amounts of nitroglycerine.
Case summary
UNASSIGNED
A 59-year-old woman with advanced PVOD was referred to our hospital. We performed a right heart catheterization after administering combination therapy with selexipag and macitentan, and intravenous nitroglycerine at 0.2 and 0.4 μg/kg/min decreased pulmonary arterial wedge pressure (PAWP) and mean pulmonary arterial pressure (PAP) to minimal levels. The final dose of 1 μg/kg/min yielded an ∼20% decrease in mean PAP and pulmonary vascular resistance (PVR).
Discussion
UNASSIGNED
Here, we described the acute effect of intravenous nitroglycerine on PAWP and PVR in a patient with PVOD. This case highlights the venodilation response even in advanced PVOD, suggesting the importance of further research into selective venous dilators as potent therapy.
Identifiants
pubmed: 37575546
doi: 10.1093/ehjcr/ytad365
pii: ytad365
pmc: PMC10415858
doi:
Types de publication
Case Reports
Langues
eng
Pagination
ytad365Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
Déclaration de conflit d'intérêts
Conflict of interest: None declared.
Références
Eur J Clin Pharmacol. 1980 Nov;18(6):455-60
pubmed: 6780368
Tohoku J Exp Med. 2019;247(2):69-73
pubmed: 30700638
Circulation. 2011 May 17;123(19):2132-44
pubmed: 21576678
J Intern Med. 2010 Mar;267(3):322-30
pubmed: 19694900
Circulation. 2002 May 21;105(20):2398-403
pubmed: 12021227
Eur J Intern Med. 2018 May;51:1-10
pubmed: 29482882
Braz J Med Biol Res. 2005 Feb;38(2):185-95
pubmed: 15785829
Chest. 1998 Jan;113(1):237-40
pubmed: 9440597
Eur Respir J. 2009 Jan;33(1):189-200
pubmed: 19118230
Eur Heart J. 2022 Oct 11;43(38):3618-3731
pubmed: 36017548