Protective effect of sildenafil in pulmonary hypertensive child with congenital heart disease


  • Adnan Khtan Department of Pediatric Cardiology, Ministry of Health, Maternity and Pediatric Hospital, Hilla, Iraq.
  • Yasmeen Ali Hussien Faculty of Pharmacy, Alkafeel University, Najaf, Iraq.



sildenafil, pulmonary hypertensive child, congenital heart disease


Objective Pulmonary hypertension has been described as an elevation in mean pulmonary artery pressure (PAP) >25 mmHg at rest or 30 mmHg during exercise, which can be classified into primary and secondary pulmonary hypertension.
Methods In this study, subjects were divided into two groups of patients and controls. The patients were treated with Sildenafil for 3 months, starting with 0.2 mg/kg/dose, six times daily and then the dose was increased with an increment of 0.2 mg/kg/dose every 15 days. Echocardiography examination, including pulmonary artery pressure, tricuspid regurgitation velocity, and pulmonary artery acceleration time, as well as oxygen saturation (SpO2) rate were measured every 15 days.
Results The results revealed that a significant decrease (P < 0.05) in the pulmonary artery and tricuspid pressure, and a significant increase (P < 0.05) in the rate of blood oxygen saturation and pulmonary artery acceleration time have been found.
Conclusion The results of this study reveal that Sildenafil has a great effect in the treatment of the secondary type of pulmonary hypertension and has a negligible effect on primary pulmonary hypertension.


1. Oudiz RJ, Rubin LJ. Exercise-induced pulmonary arterial hypertension: a new addition to the spectrum of pulmonary vascular diseases. Circulation. 2008;118:2120–2121.
2. Nagendran J, Archer SL, Soliman D, Gurtu V, Moudgil R, Haromy A, et al. Phosphodiesterase type 5 is highly expressed in the hypertrophied human right ventricle, and acute inhibition of phosphodiesterase type 5 improves contractility. Circulation. 2007;116:238–248.
3. Holcomb BW, Loyd JE, Ely EW, Johnson J, Robbins IM. Pulmonary veno-occlusive disease: a case series and new observations. Chest. 2000;118:1671–1679.
4. Rich S, Dantzker DR, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, et al. Primary pulmonary hypertension. A national prospective study. Ann Intern Med. 1987;107:216–223.
5. Schermuly RT, Pullamsetti SS, Kwapiszewska G, Dumitrascu R, Tian X, Weissmann N, et al. Phosphodiesterase 1 upregulation in pulmonary arterial hypertension: target for reverse-remodeling therapy. Circulation. 2007;115:2331–2339.
6. Michelakis ED, Wilkins MR, Rabinovitch M. Emerging concepts and translational priorities in pulmonary arterial hypertension. Circulation. 2008;118:1486–1495.
7. Bull BS, Koepke JA, Simson E, van Assendelft OW. Procedure for Determining Packed Cell Volume by the Microhematocrit Method. 3rd Ed.; NCCLS Document H7-A3, 2000 (approved standard).
8. Lewis SM, Barbara JB, Bates I. Dacie and Lewis Practical Haematology. 2006.
9. Chan ED, Chan MM, Chan MM. Pulse oximetry: understanding its basic principles facilitates appreciation of its limitations. Respir Med. 2013;107:789–799.
10. Fisher MR, Forfia PR, Chamera E, Housten-Harris T, Champion HC, Girgis RE, et al. Accuracy of doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med. 2009;179:615–621.
11. Mason JW, Hancock EW, Gettes LS, Bailey JJ, Childers R, Deal BJ, et al. Recommendations for the standardization and interpretation of the electrocardiogram. J Am Coll Cardiol. 2007;49:1128–1135.
12. IBM. IBM SPSS Statistics 20 Core System User’s Guide. SPSS, 2011.
13. Mourani PM, Sontag MK, Ivy DD, Abman SH. Effects of long-term sildenafil treatment for pulmonary hypertension in infants with chronic lung disease. J Pediatr. 2009;154:379–384.
14. Barreto AC, Franchi SM, Castro CR, Lopes AA. One-year follow-up of the effects of sildenafil on pulmonary arterial hypertension and veno-occlusive disease. Braz J Med Biol Res. 2005;38:185–195.
15. Kothari SS, Duggal B. Chronic oral sildenafil therapy in severe pulmonary artery hypertension. Indian Heart J. 2002;54:404–409.
16. Machado RF, Martyr S, Kato GJ, Barst RJ, Anthi A, Robinson MR, et al. Sildenafil therapy in patients with sickle cell disease and pulmonary hypertension. Br J Haematol. 2005;130:445–453.
17. Zampi JD, Cross R, Fine BR. Moss and Adams’ heart disease in infants, children, and adolescents: including the fetus and young adult. JAMA. 2008;300:2676–2677.
18. Sastry BK, Narasimhan C, Reddy NK, Raju BS. Clinical efficacy of sildenafil in primary pulmonary hypertension: a randomized, placebo-controlled, double-blind, crossover study. J Am Coll Cardiol. 2004;43:1149–1153.
19. Atz AM, Wessel DL. Sildenafil ameliorates effects of inhaled nitric oxide withdrawal. Anesthesiology. 1999;91:307–310.
20. Michelakis ED, Tymchak W, Noga M, Webster L, Wu XC, Lien D, et al. Longterm treatment with oral sildenafil is safe and improves functional capacity and hemodynamics in patients with pulmonary arterial hypertension. Circulation. 2003;108:2066–2069.
21. Bernstein D. The cardiovascular system. In: Behrman RE, Klagman RM, Jenson HB (eds.). Nelson Textbook of Pediatrics. 18th Ed.; WB Sauders, California, 2008.



How to Cite

Khtan, A., & Hussien, Y. A. (2018). Protective effect of sildenafil in pulmonary hypertensive child with congenital heart disease. Journal of Contemporary Medical Sciences, 4(4), 211–215.