Prostacyclin Prostacyclin is a metabolite of arachidonic acid that is produced primarily in the vascular endothelium. Its major pharmacologic actions include potent vasodilatation of the pulmonary and systemic arterial and venous beds and inhibition of platelet aggregation. Prostacyclin is administered through a permanent intravenous catheter and delivered by an ambulatory infusion system. The delivery system is complex and requires patients to learn the techniques of sterile preparation, operation of the pump, and care of the intravenous catheter. Others Diuretics are frequently required to reduce excessive edema in patients with right heart failure.
Digoxin can increase cardiac output and reduce circulating neurohormones.
Patients with hypoxemia, either at rest or with exercise, should receive supplemental oxygen. The immediate reduction in pulmonary artery pressure and pulmonary vascular resistance is associated with an improvement in right ventricular function. Bilateral lung transplantation is preferred at most centers, because there is greater pulmonary vascular reserve if the patient sustains rejection or infection. Single lung transplantation may be preferred in some situations because the operation is technically less challenging and the waiting time is shorter. As with any type of organ transplantation, the major long-term morbidity and mortality are related to the high incidence of rejection and opportunistic infections.