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Sildenafil no tratamento da hipertens o pulmonar associada a lúpus eritematoso sistêmico e síndrome antifosfolipídio  [cached]
Souza Eduardo José do Rosário e,Garib Junia Rios,Garib Nasim Michel,Pádua Paulo Madureira de
Jornal de Pneumologia , 2003,
Abstract: Hipertens o pulmonar grave é uma doen a debilitante, com expectativa de vida reduzida, que acomete adultos jovens. Complica es pleuropulmonares no lúpus eritematoso sistêmico ocorrem em 50% a 70% dos pacientes. A hipertens o pulmonar grave no lúpus eritematoso sistêmico é rara e tem prognóstico reservado. Descreve-se, pela primeira vez, um paciente com hipertens o pulmonar grave associada a lúpus eritematoso sistêmico e síndrome antifosfolipídio secundário que apresentou boa resposta ao uso do sildenafil oral, após falha do tratamento convencional com corticosteróides, ciclofosfamida, warfarin e diltiazem.
Resolu o do "shunt" direita-esquerda após uso do sildenafil como tratamento de hipertens o pulmonar primária  [cached]
Silva Sérgio Marques da,Valeri Carla Bastos,Bogossian Humberto Bassit,Jardim Carlos
Jornal de Pneumologia , 2003,
Abstract: Hipertens o pulmonar primária é uma doen a rara, progressiva e com alta mortalidade, cujo tratamento baseia-se em medica es de alto custo e pouco disponíveis em nosso meio. O sildenafil é um vasodilatador de fácil administra o por via oral, com indica o primária para disfun o erétil e que recentemente tem sido descrito como op o terapêutica para a hipertens o pulmonar primária. Relata-se o caso de uma paciente de 21 anos com diagnóstico de hipertens o pulmonar primária, que apresentou piora abrupta da satura o de oxigênio, com abertura do forame oval e shunt direita-esquerda, evidenciados ao ecocardiograma. Foi introduzido sildenafil na dose de 225mg/dia com melhora progressiva da oxigena o e revers o do shunt após 40 dias. Os autores acreditam que o sildenafil seja uma op o no tratamento da hipertens o pulmonar primária, embora estudos clínicos que comprovem sua seguran a e eficácia ainda sejam necessários.
A Hipertens o Arterial Pulmonar Nos Pacientes Infectados Pelo HIV
Petrosillo Nicola,Stefania Cicalini
PVRI Review , 2010,
Abstract: Nos últimos anos, tem sido dado maior enfoque ao papel patogênico do HIV e as manifesta es clínicas relacionadas à hipertens o pulmonar associada ao HIV (HP-HIV), que representa atualmente um dos eventos mais graves durante a evolu o da infec o pelo HIV. HP-HIV ocorre em fases precoces e tardias da infec o pelo HIV e n o parece estar relacionada com o grau de deficiência imunológica. Muitos dos sintomas em HP-HIV resultam da disfun o ventricular direita: a primeira manifesta o clínica é a intolerancia esfor o e a dispnéia que pode se apresentar mesmo ao repouso. A ecocardiografia tem provado ser uma ferramenta extremamente útil para o diagnóstico da HP-HIV e o ecodopplercardiograma pode ser utilizado para estimar a press o sistólica da artéria pulmonar e para avaliar os efeitos da terapia. A avalia o das medidas hemodinamicas pelo cateterismo permanece, no entanto, o melhor teste para avaliar a resposta ao tratamento. O cateterismo cardíaco é obrigatório para a caracteriza o da doen a e excluir "shunt" cardíaco como etiologia da HP. Vasodilatadores têm sido amplamente utilizados no tratamento da hipertens o pulmonar, uma vez que a vasoconstri o é uma característica determinante da doen a. Mais recentemente, as terapias altamente eficazes para hipertens o arterial pulmonar, foram disponibilizadas, incluindo os prostanóides, antagonistas dos receptores da endotelina e inibidores da fosfodiesterase 5, permitindo uma melhoria dos sintomas e melhor prognóstico. No entanto, HP-HIV continua a ser uma doen a progressiva onde o tratamento é muitas vezes insatisfatório e n o há cura. Como novos tratamentos anti-retrovirais ser o introduzidos, os clínicos devem esperar encontrar um número crescente de casos de hipertens o pulmonar em pacientes infectados pelo HIV no futuro.
Sildenafil no tratamento da hipertens?o pulmonar após cirurgia cardíaca
Bentlin, Maria Regina;Saito, Adriana;De Luca, Ana Karina C.;Bossolan, Grasiela;Bonatto, Rossano C.;Martins, Antonio S.;Rugolo, Ligia M. S. S.;
Jornal de Pediatria , 2005, DOI: 10.1590/S0021-75572005000300015
Abstract: objective: to report on the use of sildenafil for pulmonary hypertension treatment of a newborn patient after cardiac surgery. description: a female, full term newborn infant with diagnosis of double outlet right ventricle, pulmonary hypoplasia and subaortic ventricular septal defect, was submitted to blalock surgery in the first week of life. in postoperative the newborn had pulmonary hypertension and persistent hypoxia, without response to nitric oxide, but with improved oxygenation after continuous intravenous infusion of prostaglandin e1. after several failed attempts to discontinue prostaglandin e1, oral sildenafil was used. there was a decrease in pulmonary vascular resistance with consequent oxygenation improvement and 48 hours later it was possible to discontinue prostaglandin e1 infusion. comments: sildenafil can be an alternative therapy for pulmonary hypertension, especially when there is no response to conventional therapy.
Impacto do sildenafil sublingual na hipertens?o pulmonar de pacientes com insuficiência cardíaca
Freitas Jr., Aguinaldo Figueiredo de;Bacal, Fernando;Oliveira Jr., José de Lima;Santos, Ronaldo Honorato Barros;Moreira, Luiz Felipe Pinho;Silva, Christiano Pereira;Mangini, Sandrigo;Carneiro, Rodrigo Moreno Dias;Fiorelli, Alfredo Inácio;Bocchi, Edimar Alcides;
Arquivos Brasileiros de Cardiologia , 2009, DOI: 10.1590/S0066-782X2009000200008
Abstract: background: pulmonary hypertension (ph) is a factor of poor prognosis in the postoperative period of heart transplant (ht) and thus, the study of the degree of reversibility to vasodilators is mandatory during the preoperative assessment. objective: to evaluate the pulmonary and systemic hemodynamic effects of sildenafil as a vasodilator during the ph reversibility test in patients that are candidates to ht. methods: patients awaiting ht were submitted to the measurement of systemic and pulmonary hemodynamic variables before and after the administration of a single sublingual dose of 100 mg of sildenafil during right heart catheterization. results: fourteen patients (age: 47±12 years, 71.4% men) with advanced heart failure ejection fraction (ef) 25 ± 7%, functional class (fc - nyha) fc iii - 6 and fc iv - 8, were evaluated in this study. the acute administration of sildenafil showed to be effective in decreasing the systolic (62.4 ± 12.1 vs 51.5 ± 9.6 mmhg, ci=95%, p<0.05) and mean (40.7 ± 7.3 vs 33.8 ± 7.6 mmhg, ci=95%, p <0.05) pressures of the pulmonary artery. there was also a significant decrease in the pulmonary (4.2 ± 3 vs 2.0 ± 0.9 uwood, ci=95%, p<0.05) and systemic vascular resistance (22.9 ± 6.8 vs 18.6 ± 4.1 wood, ci=95%, p<0.05), associated to an increase in the cardiac output (3.28 ± 0.79 vs 4.12 ±1.12 uwood, ci=95%, p<0.05) without, however, significantly interfering in the systemic arterial pressure (87.8 ± 8.2 vs 83.6 ± 9.1 mmhg, ci=95%, p=0.3). conclusion:the sublingual administration of sildenafil is an effective and safe alternative as a vasodilator during the ph reversibility test in patients with heart failure and awaiting a ht.
Resolu??o do "shunt" direita-esquerda após uso do sildenafil como tratamento de hipertens?o pulmonar primária
Silva, Sérgio Marques da;Valeri, Carla Bastos;Bogossian, Humberto Bassit;Jardim, Carlos;Demarzo, Sérgio Eduardo;Souza, Rogério;
Jornal de Pneumologia , 2003, DOI: 10.1590/S0102-35862003000500010
Abstract: primary pulmonary hypertension is a rare, progressive disease with high mortality rates. the treatment of primary pulmonary hypertension is still based on high-cost drugs, not yet available in developing countries. recently, the use of sildenafil as an alternative drug for primary pulmonary hypertension treatment has been reported. it is reported a case of a 21 year-old female patient with primary pulmonary hypertension, who presented an acute worsening of symptoms and decrease of oxygen saturation. the investigation revealed the existence of a patent oval foramen not previously seen, with right-to-left shunt. sildenafil treatment was instituted in escalating doses. after 40 days of treatment, the echocardiogram showed resolution of the shunt, concomitant to oxygenation improvement. the authors believe that sildenafil is a feasible alternative for primary pulmonary hypertension treatment, although larger clinical trials are necessary to determine its clinical safety and efficacy.
Sildenafil no tratamento da hipertens?o pulmonar associada a lúpus eritematoso sistêmico e síndrome antifosfolipídio
Souza, Eduardo José do Rosário e;Garib, Junia Rios;Garib, Nasim Michel;Pádua, Paulo Madureira de;
Jornal de Pneumologia , 2003, DOI: 10.1590/S0102-35862003000500009
Abstract: severe pulmonary hypertension is a debilitating disease with short life expectancy that often affects young people. pleuropulmonary complications of systemic lupus erythematosus occur in 50-70% of patients. severe symptomatic pulmonary hypertension in systemic lupus erythematosus is rare and carries a bad prognosis because a fatal outcome can occur within months. the authors describe, for the first time, a patient with systemic lupus erythematosus with severe pulmonary hypertension and secondary antiphospholipid syndrome who responded favorably to oral sildenafil, after unsuccessful use of prednisone, intravenous cyclophosphamide, warfarin and diltiazem.
Tadalafil para o tratamento da hipertens?o arterial pulmonar idiopática
Carvalho, Adriana Castro de;Hovnanian, André Luiz;Fernandes, Caio Julio César dos Santos;Lapa, M?nica;Jardim, Carlos;Souza, Rogério;
Arquivos Brasileiros de Cardiologia , 2006, DOI: 10.1590/S0066-782X2006001800027
Abstract: phosphodiesterase inhibitors like sildenafil have already been shown to improve functional capacity and hemodynamics in the treatment of pulmonary arterial hypertension. few studies address the effects of new phosphodiesterase inhibitors as tadalafil. we report a case of a patient with idiopathic pulmonary arterial hypertension in functional class iv (new york heart association) with significant response to treatment with tadalafil.
Seguimento de dois anos em pacientes com hipertens?o arterial pulmonar sob tratamento com sildenafila
Franchi, Sonia Meiken;Barreto, Alessandra Costa;Cícero, Cristina;Castro, Claudia Regina Pinheiro;Ribeiro, Zilma Ver?osa de Sá;Lopes, Antonio Augusto;
Arquivos Brasileiros de Cardiologia , 2010, DOI: 10.1590/S0066-782X2010005000041
Abstract: background: the long-term effects of drugs developed for the control of pulmonary arterial hypertension (pah) are little known, since multicenter studies usually last 12 to 16 weeks. objective: to evaluate the two-year outcome of pah patients receiving monotherapy with sildenafil (a phosphodiesterase-5 inhibitor), with regard to their functional capacity. methods: twenty four patients (ages between 8 and 54 years) with idiopathic pah (ipah, n = 9) or congenital heart disease-associated pah (chd-pah, n = 15) were treated with sildenafil for two years, with daily oral doses ranging from 60 to 225 mg (tid). physical capacity was assessed by the distance walked in the 6-minute walk test (dw6m) and by the degree of dyspnea at the end of the walk (borg scale); peripheral oxygen saturation was also recorded (spo26m, pulse oximetry). results: in the 18 patients who completed the two-year follow-up, there was a progressive and sustained increase in dw6m, both in the ipah group (from 239 ± 160 m to 471 ± 66 m, p = 0.0076) and in the chd-pah group (from 361 ± 144 m to 445 ± 96m, p = 0.0031), with improvement of dyspnea at the end of the walk (p<0.05 for both groups). no decrease in spo26m was observed in the groups; in patients with chd-pah, in particular, spo26m went from 77 ± 20% to 79 ± 16% (p = 0.5248). five deaths occurred (three in the ipah group) and one patient was lost to follow-up during the study period. conclusion: in a two-year follow-up, sildenafil proved useful in the control of the functional status of pah patients, with significant improvement in both groups considered.
Hipertens?o arterial pulmonar hereditária apresentando-se como venopatia oclusiva
Franchi, Sonia Meiken;Aiello, Vera D.;Lopes, Antonio Augusto;
Arquivos Brasileiros de Cardiologia , 2011, DOI: 10.1590/S0066-782X2011000900019
Abstract: a 33-year-old male with severe hereditary pulmonary arterial hypertension had a confirmed diagnosis of occlusive venopathy and microvasculopathy. he remained stable for three and a half years on oral sildenafil, 75 mg t.i.d. (six-minute walked distance of 375 m vs 105 m at baseline), but required addition of bosentan (125 mg b.i.d.), subsequently. despite the fatal outcome at five years post-diagnosis, the observations suggest a potential usefulness of vasodilators as a bridge for lung transplant in selected cases with significant venous/capillary involvement. the occurrence of veno-occlusive and capillary lesions in the familial form of pulmonary arterial hypertension reinforces the difficulties with the current classification of the disease.
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