Sildenafil treatment successfully resolved acute right ventricular dysfunction and pulmonary embolism in a 26-year-old man, with normal RV function restored at 3 months.
Case Report (n=1)
No
Does sildenafil improve right ventricular function in a patient with acute right ventricular dysfunction following pulmonary embolism?
Sildenafil may be a potential therapeutic option for selected patients with acute right ventricular dysfunction secondary to acute pulmonary embolism.
Abstract Introduction We present a previously healthy 26-year-old man who developed right heart dysfunction following pulmonary embolism, successfully treated with sildenafil. Case Presentation A 26-year-old man developed diarrhoea and dehydration while in Egypt. Following his return flight to London, he experienced calf pain. At a local hospital, computed tomography pulmonary angiography (CTPA) revealed bilateral central pulmonary emboli involving the main pulmonary arteries, and anticoagulation was commenced. As his condition failed to improve, he was referred to our care after 10 days. Repeat CTPA demonstrated progression with complete occlusion of the left lower lobe pulmonary artery and a large area of infarction. Transthoracic echocardiography (ECHO) showed a dilated right ventricle and impaired radial function with preserved longitudinal systolic function (pulmonary artery systolic pressure 31 mmHg and right atrial pressure 10-15 mmHg). He was commenced on heparin and antibiotic therapy. Thrombolysis or thrombectomy was not pursued, as the thrombi had been present for approximately two weeks before presentation and significant infarction was evident in the left lower lobe. Based on these findings, sildenafil 25 mg three times daily was initiated and later increased to 50 mg. Following clinical improvement, he was transitioned to rivaroxaban and discharged. At three months, repeat CTPA showed no evidence of PE and echocardiography showed normal right ventricular function (fractional area change 48%, tricuspid annular plane systolic excursion 2.9 cm). Hence, sildenafil was discontinued, and he remained well one year after discharge. Discussion and Conclusion This case illustrates that sildenafil may be considered in selected patients with acute right ventricular dysfunction in the context of acute pulmonary embolism. Our institution has been using Sildenafil for this indication since 2015. This abstract is funded by: None
Priya et al. (Fri,) conducted a case report in Acute right ventricular dysfunction following pulmonary embolism (n=1). Sildenafil was evaluated. Sildenafil treatment successfully resolved acute right ventricular dysfunction and pulmonary embolism in a 26-year-old man, with normal RV function restored at 3 months.