Impacto do sildenafil sublingual na hipertens？o pulmonar de pacientes com insuficiência cardíaca

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.