Abstract
Introduction. Pulmonary arterial hypertension (PAH) is a common complication of congenital heart diseases (CHD), with most cases
occurring in patient with congenital cardiac shunts. Increased pulmonary vascular resistance affects the postoperative period, determines the duration of mechanical ventilation and frequency of complications associated with it, the possibility of pulmonary hypertensive crisis.
Material and methods. 87 patients of the first year of life were including in this retrospective observational study. All patients underwent radical correction for CHD and had confirmed high PAH in the early postoperative period. Infants were divided in 2 groups:
group 1 consisted of 77 patients, who didn't received bosentan, and group 2 of 10 patients with bosentan administration. The median
weight amounted 3.8 kg and 3.9 kg in the first and second groups respectively. All patients underwent radical correction of heart
defects: septal defects, atrioventricular canal, total arterial trunk, coarctation of the aorta, total anomalous pulmonary venous
drainage, aortopulmonary window.
Results. Patients of the second group had a lower systolic pulmonary artery pressure (MPAP) after 48 hours of operation (p=0.023,
95% confidence inteval (CI) [0.55-0.96] odds ratio (OR) - 0.73). The management patients with bosentan in complex therapy of
pulmonary hypertension in the early postoperative period allowed to reduce the duration of mechanical ventilation (p=0.01, 95% CI
[0.92-0.99], OR=0.96), duration the use of inotropic agents (p=0.046, 95% CI [0.06-0.98], OR=0.25) and the need for prolonged
muscle relaxation (p=0.017, 95% CI [0.04-0.74], OR=0.17).
Conclusion. The use of bosentan as part of complex management treatment of patients after correction of CHD has resulted in faster
decreasing of MPAP, reducing the duration of mechanical lung ventilation, inotropic support and muscle relaxante.
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