968
A.A.H. El Midany et al. / Interactive CardioVascular and Thoracic Surgery
[14] Zeng WJ, Lu XL, Xiong CM, Shan GL, Liu ZH, Ni XH et al. The efficacy and safety of sildenafil in patients with pulmonary arterial hypertension associated with the different types of congenital heart disease. Clin Cardiol 2011;34:513–8. [15] Molaei A, Mogaddam MYA, Davari PN, Shahmohammadi A, Meraji M. Validity of sildenafil test in patients with pulmonary arterial hypertension associated with congenital heart disease according to clinical and echocardiographic parameters. J Teh Univ Heart Ctr 2009;4:103–8. [16] Raja SG, Danton MD, MacArtur KJ, Pollock JC. Effects of escalating dose of sildenafil on hemodynamic and gas exchange in children with pulmonary hypertension and congenital cardiac defects. J Cardiothorac Vasc Anesth 2007;21:203–7. [17] Peiravian F, Amirghofran AA, Borzouee M, Ajami GH, Sabri MR, Kolaee S. Oral sildenafil to control pulmonary hypertension after congenital heart surgery. Asian Cardiovasc Thorac Ann 2007;15:113–7. [18] Bentlin MR, Saito A, De Luca AK, Bossolan G, Bonatto RC, Martins AS et al. Sildenafil for pulmonary hypertension treatment after cardiac surgery. J Pediatr (Rio J) 2005;81:175–8. [19] Stocker C, Penny D, Brizard C, Cochrane A, Soto R, Shekerdemian L. Intravenous sildenafil and inhaled nitricoxide: a randomized trial in infants after cardiac surgery. Intensive Care Med 2003;29:1996–2003. [20] Palma G, Giordano R, Russolillo V, Cioffi S, Palumbo S, Mucerino M et al. Sildenafil therapy for pulmonary hypertension before and after pediatric congenital heart surgery. Tex Heart Inst J 2011;38:238–42. [21] Vassalos A, Peng E, Young D, Walker S, Pollock J, Macarthur K et al. Pre-operative sildenafil and pulmonary endothelial-related complications following cardiopulmonary bypass: a randomised trial in children undergoing cardiac surgery. Anaesthesia 2011;66:472–80. [22] Namachivayam PN, Theiler J, Butt WW, Cooper SM, Penny DJ, Shekerdemian LS. Sildenafil prevents pulmonary hypertension after withdrawal of nitric oxide in children. Am J Respir Crit Care Med 2006;174: 1042–7. [23] Baquero H, Soliz A, Neira F, Venegas ME, Sola A. Oral sildenafil in infants with persistent pulmonary hypertension of the newborn: a pilot randomized blinded study. Pediatrics 2006;117:1077–83.
eComment. Further study needed Authors: Nadia N. Quraishi, Thomas I. Lemon and Lori F. Black Cardiff School of Medicine, Cardiff University, Cardiff, UK doi: 10.1093/icvts/ivt424 © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. We thank El Midany et al. [1] for their innovative paper on perioperative sildenafil therapy for pulmonary hypertension in infants undergoing congenital cardiac defect closure. As we know, ventricular septal defect (VSD) is associated with significant perioperative morbidity and mortality. The authors suggest that sildenafil is a good and simple alternative therapy for secondary hypertension, including persistent pulmonary hypertension which is associated with VSDs, particularly in resource limited areas. As the authors have correctly highlighted, there are no definite parameters regarding treatment of pulmonary hypertension in children. As such, they are trying to quantify, in graphical format, results which are reliant on a self-proposed baseline. Furthermore, the authors are restricted by the fact that they have only provided reference to a few similar studies. The study’s efficacy would be enhanced by performing a systematic review of the available literature surrounding the subject. There needs to be a full randomized controlled trial into the effectiveness of sildenafil in controlling pulmonary hypertension in children with congenital heart defects. We thank El Midany et al. for their interesting work into this area, and for highlighting the commencement of potential therapies for this patient cohort. Sildenafil would seem to be a possible viable adjuvant for postoperative pulmonary hypertension. Conflict of interest: none declared. Reference [1] El Midany AAH, Mostafa EA, Azab S, Hassan GA. Perioperative sildenafil therapy for pulmonary hypertension in infants undergoing congenital cardiac defect closure. Interact CardioVasc Thorac Surg 2013;17:963–8.
A.A.H. El Midany et al. / Interactive CardioVascular and Thoracic Surgery
[14] Zeng WJ, Lu XL, Xiong CM, Shan GL, Liu ZH, Ni XH et al. The efficacy and safety of sildenafil in patients with pulmonary arterial hypertension associated with the different types of congenital heart disease. Clin Cardiol 2011;34:513–8. [15] Molaei A, Mogaddam MYA, Davari PN, Shahmohammadi A, Meraji M. Validity of sildenafil test in patients with pulmonary arterial hypertension associated with congenital heart disease according to clinical and echocardiographic parameters. J Teh Univ Heart Ctr 2009;4:103–8. [16] Raja SG, Danton MD, MacArtur KJ, Pollock JC. Effects of escalating dose of sildenafil on hemodynamic and gas exchange in children with pulmonary hypertension and congenital cardiac defects. J Cardiothorac Vasc Anesth 2007;21:203–7. [17] Peiravian F, Amirghofran AA, Borzouee M, Ajami GH, Sabri MR, Kolaee S. Oral sildenafil to control pulmonary hypertension after congenital heart surgery. Asian Cardiovasc Thorac Ann 2007;15:113–7. [18] Bentlin MR, Saito A, De Luca AK, Bossolan G, Bonatto RC, Martins AS et al. Sildenafil for pulmonary hypertension treatment after cardiac surgery. J Pediatr (Rio J) 2005;81:175–8. [19] Stocker C, Penny D, Brizard C, Cochrane A, Soto R, Shekerdemian L. Intravenous sildenafil and inhaled nitricoxide: a randomized trial in infants after cardiac surgery. Intensive Care Med 2003;29:1996–2003. [20] Palma G, Giordano R, Russolillo V, Cioffi S, Palumbo S, Mucerino M et al. Sildenafil therapy for pulmonary hypertension before and after pediatric congenital heart surgery. Tex Heart Inst J 2011;38:238–42. [21] Vassalos A, Peng E, Young D, Walker S, Pollock J, Macarthur K et al. Pre-operative sildenafil and pulmonary endothelial-related complications following cardiopulmonary bypass: a randomised trial in children undergoing cardiac surgery. Anaesthesia 2011;66:472–80. [22] Namachivayam PN, Theiler J, Butt WW, Cooper SM, Penny DJ, Shekerdemian LS. Sildenafil prevents pulmonary hypertension after withdrawal of nitric oxide in children. Am J Respir Crit Care Med 2006;174: 1042–7. [23] Baquero H, Soliz A, Neira F, Venegas ME, Sola A. Oral sildenafil in infants with persistent pulmonary hypertension of the newborn: a pilot randomized blinded study. Pediatrics 2006;117:1077–83.
eComment. Further study needed Authors: Nadia N. Quraishi, Thomas I. Lemon and Lori F. Black Cardiff School of Medicine, Cardiff University, Cardiff, UK doi: 10.1093/icvts/ivt424 © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. We thank El Midany et al. [1] for their innovative paper on perioperative sildenafil therapy for pulmonary hypertension in infants undergoing congenital cardiac defect closure. As we know, ventricular septal defect (VSD) is associated with significant perioperative morbidity and mortality. The authors suggest that sildenafil is a good and simple alternative therapy for secondary hypertension, including persistent pulmonary hypertension which is associated with VSDs, particularly in resource limited areas. As the authors have correctly highlighted, there are no definite parameters regarding treatment of pulmonary hypertension in children. As such, they are trying to quantify, in graphical format, results which are reliant on a self-proposed baseline. Furthermore, the authors are restricted by the fact that they have only provided reference to a few similar studies. The study’s efficacy would be enhanced by performing a systematic review of the available literature surrounding the subject. There needs to be a full randomized controlled trial into the effectiveness of sildenafil in controlling pulmonary hypertension in children with congenital heart defects. We thank El Midany et al. for their interesting work into this area, and for highlighting the commencement of potential therapies for this patient cohort. Sildenafil would seem to be a possible viable adjuvant for postoperative pulmonary hypertension. Conflict of interest: none declared. Reference [1] El Midany AAH, Mostafa EA, Azab S, Hassan GA. Perioperative sildenafil therapy for pulmonary hypertension in infants undergoing congenital cardiac defect closure. Interact CardioVasc Thorac Surg 2013;17:963–8.
