Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Cardiothoracic Surgery

Background: Left side heart disease (LHD) represents the most common causes of pulmonary hypertension (PH). Whether caused by systolic or diastolic dysfunction or valvular heart disease, the increase in left atrial pressure causes a passive increase in pulmonary pressure. In some patients, a superimposed active component caused by pulmonary arterial vasoconstriction and vascular remodeling lead to a further increase in pulmonary arterial pressure. When present, PHTN is associated with a worse prognosis in patients with LHD. In addition to local abnormalities in nitric oxide and endothelin production, gene modifiers such as serotonin polymorphisms may be associated with the pathogenesis of PHTN in LHD.. Recent studies suggest that sildenafil, a phosphodiesterase-5 inhibitor, is a promising in the treatment of PHTN in LHD. Objective: to assess the effect of the Sildenafil on the pulmonary hypertension in patient with mitral valve decease .Patients & Methods: This study was undertaken in the Department of Cardiothoracic Surgery of Kasr El Aini Faculty of Medicine, Cairo University after approval of the local ethical committee between 2015 and 2016. It enrolled 60 adult patients submitted to mitral valve surgery having mitral valve lesion and associated PHTN. Patients were allocated into either of 2 groups each having equal number (no=30) and properly-matched preoperative risk factors. Group A (no=30) with pulmonary artery pressure (50-80 mmHg) and group B (no=30) with pulmonary artery pressure above 80mmHg contained patients in whom Sildenafil Citrate was given . Hemodynamics (ABP, HR, CVP, PASP in mmHg) as well as mitral valve functions and LV performance (LVEF%) were assessed by clinical assessment and before surgery, during ICU and hospital stay, and 6 months post {u2013}operative Conclusion: Use of Sildenafil resulted in a significant reduction in pulmonary artery pressure Result: .In our study in group A the mean post six month pulmonary hypertension was 28.28+5.0mmHg while in group B was 46.40+ 4.8mmHg which showed an significant statistical difference as P value was 0.02.

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