Role of Sildenafil in Acute Posttransplant Right Ventricular Dysfunction: Successful Experience in 13 Consecutive Patients L.S. De Santo, C. Mastroianni, G. Romano, C. Amarelli, C. Marra, C. Maiello, N. Galdieri, A. Della Corte, M. Cotrufo, and G. Caianiello ABSTRACT Background. Superimposed acute right ventricular dysfunction in the setting of preex- isting pulmonary hypertension is a nearly fatal complication after heart transplantation. The optimal treatment modality remains a matter of debate. Recently, sildenafil citrate, a nonselective pulmonary vasodilator, has gained popularity in the treatment of pulmonary hypertension in transplant candidates. Methods. Herein we have presented a series of 13 patients in whom sildenafil was used to treat right ventricular dysfunction and pulmonary hypertension as detected by trans- esophageal echocardiography and Swan-Ganz right heart catheterization after heart transplant. Their characteristics were mean age 49  11.4 years; 38.4% with previous cardiac procedures, 30.8% status I, basal pulmonary vascular resistance index 10.4  4.6 WoodU, mean transpulmonary gradient 18.7  5.4 mmHg. In addition to conventional inodilator support, we administered 1 to 3 mg per kilogram of sildenafil. Complete hemodynamic measurements were obtained before and after the institution of the therapy and at 1-month follow-up. Results. Within the first 72 hours, acute right ventricular dysfunction resolved in all cases without untoward side effects or significant systemic impact. Sildenafil significantly decreased the transpulmonary gradient and pulmonary vascular resistance index relative to baseline values; 5.6  1.82 versus 10.4  4.6 WU, (P  .05), 13.5  3.4 mm Hg versus 18.7  5.4 mm Hg (P  .05), respectively. Improved indices of right ventricular function were observed on echocardiographic monitoring. After 1 month, sildenafil treatment was discontinued. Conclusion. Management of acute right ventricular dysfunction in heart transplant recipients with pulmonary hypertension using sildenafil proved safe and effective. A CUTE RIGHT VENTRICULAR (RV) failure is a frequent cause of perioperative morbidity and mor- tality after orthotopic heart transplantation, 1 so that the presence of meaningful irreversible pulmonary hyperten- sion (PH) is a major contraindication to cardiac transplan- tation. PH may be exacerbated by pulmonary endothelial dysfunction owing to cardiopulmonary bypass during car- diac transplantation. RV function is frequently adversely affected by ischemia-reperfusion injury from the procedure. The regulation of pulmonary vascular tone to treat this lethal clinical syndrome is still under active investigation. 2,3 In our case series, we have described the effects of sildenafil in patients with overt acute right heart failure after heart transplantation. The main hemodynamic outcome mea- sures were central venous pressure (CVP), mean pulmo- nary artery pressure (MPAP), pulmonary vascular resis- tance (PVR), transpulmonary gradient (TPG), pulmonary artery wedge pressure, mean arterial pressure, and cardiac index (CI) via thermodilution. We also evaluated the length of intubation. From the University of Foggia (L.S.D.S.), Medical School, Foggia, Italy; Department of Cardiothoracic Sciences (C.M., A.D.C., M.C.), Second University of Naples, Naples, Italy; and Department of Cardiovascular Surgery and Transplant (G.R., C.A., C.M., C.M., N.G., G.C.), V. Monaldi Hospital, Naples, Italy. Address reprint requests to Luca Salvatore De Santo, Viale Colli Aminei 491, 80131 Naples, Italy. E-mail: l.desanto@unifg.it © 2008 by Elsevier Inc. All rights reserved. 0041-1345/08/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2008.05.055 Transplantation Proceedings, 40, 2015–2018 (2008) 2015