Reversibility of Medically Unresponsive Idiopathic Pulmonary Artery Hypertension with Nesiritide:One Case Report and Literature Review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WuLulu , ZhouYing , ZhangNuofu ,  LiuChunli

The Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, China;

Corresponding author：

LiuChunli, Email: chunli@gird.cn

Keywords：

Idiopathic pulmonary artery hypertension; Recombinant human brain natriuretic peptide; Phosphodiesterase type-5 inhibitors

DOI：

10.7507/1671-6205.2015142

Video：

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Objective To explore whether nesiritide (recombinant human brain natriuretic peptide, rh-BNP) could be used to treat pulmonary artery hypertension. Methods A 34-year-old female patient with severe symptomatic idiopathic pulmonary artery hypertension was reported, who was refractory to routine therapies, including prostacyclin. Therapy with continuous nesiritide infusion resulted in significant decrease in pulmonary vascular resistance and an improvement in dyspnea. The relevant literature was reviewed. Results The clinical symptoms of this patient relieved significantly after nesiritide therapy. Literature review showed that nesiritide could increase the production of nitrogen oxides and cyclic guanosine monophosphate in the body, so as to dilate the vessels which were shrunk due to hypoxia and low down the pulmonary vascular resistance. Conclusion Nesiritide is useful to treat severe pulmonary artery hypertension, and combination with phosphodiesterase type-5 inhibitors may be a brand new therapy of value.

Citation： WuLulu, ZhouYing, ZhangNuofu, LiuChunli. Reversibility of Medically Unresponsive Idiopathic Pulmonary Artery Hypertension with Nesiritide:One Case Report and Literature Review. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(6): 592-595. doi: 10.7507/1671-6205.2015142 Copy

1.	Andreas S, Konstantinos A, Stamatios L. Brain natriuretic peptide in cardiovascular diseases. Am J Med Sci,2008,335:477-483.
2.	Andrew D, Michaels AD, Jee KC, et al. Effects of intravenous nesiritide on pulmonary vascular hemodynamics in pulmonary hypertension. J Cardiac Failure,2005,11:425-431.
3.	Yap LB, Ashrafian H, Mukerjee D, et al. The natriuretic peptides and their role in disorders of right heart dysfunction and pulmonary hypertension. Clin Biochem,2004,37:847-856.
4.	Holmes SJ, Espiner EA, Richards AM, et al. Renal, endocrine, and hemodynamic effects of human brain natriuretic peptide in normal man. J Clin Endocrinol Metab,1993,76:91-96.
5.	Cargill RI, Lipworth BJ. Atrial natriuretic peptide and brain natriuretic peptide in cor pulmonale. Hemodynamic and endocrine effects. Chest,1996,110:1220-1225.
6.	Bhat G, Costea A. Reversibility of medically unresponsive pulmonary hypertension with nesiritide in a cardiac transplant recipient. ASAIO J,2003,49:608-610.
7.	Daniel J, Lenihan Mary T, Vooletich J, et al. Nesiritide may be valuable in the evaluation and treatment of secondary pulmonary hypertension. J Card Fail,2005,11(6 Suppl):S159.
8.	Chen T, Jiang N, Wang L, et al. The significance of natriuretic peptide in treatment of pulmonary hypertension after mitral valve replacement. J Thorac Cardiovasc Surg,2014,147:1362-1367.
9.	Michaels AD, Chatterjee K, De Marco T. Effects of intravenous nesiritide on pulmonary vascular hemodynamics in pulmonary hypertension. J Card Fail,2005,11:425-431.
10.	Klinger JR, Thaker S, Houtchens J, et al. Pulmonary hemodynamic responses to brain natriuretic peptide and sildenafil in patients with pulmonary arterial hypertension. Chest,2006,129:417-425.
11.	Khush KK, De Marco T, Vakharia KT, et al. Nesiritide acutely increases pulmonary and systemic levels of nitric oxide in patients with pulmonary hypertension. J Card Fail,2006,12:507-513.
12.	Stevens TL, Burnett JC Jr, Kinoshita M, et al. A functional role for endogenous atrial natriuretic peptide in a canine model of early left ventricular dysfunction. J Clin Invest,1995,95:1101-1108.
13.	Sackner-Bernstein JD, Skopicki HA, Aaronson KD. Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure. Circulation,2005,111:1487-1491.
14.	Chen HH, Lainchbury JG, Harty GJ, et al. Maximizing the natriuretic peptide system in experimental heart failure:subcutaneous brain natriuretic peptide and acute vasopeptidase inhibition. Circulation,2002,105:999-1003.
15.	Klinger JR, Petit RD, Warburton RR, et al. Neutral endopeptidase inhibition attenuates development of hypoxic pulmonary hypertension in rats. J Appl Physiol,1993,75:1615-1623.

1. Andreas S, Konstantinos A, Stamatios L. Brain natriuretic peptide in cardiovascular diseases. Am J Med Sci,2008,335:477-483.
2. Andrew D, Michaels AD, Jee KC, et al. Effects of intravenous nesiritide on pulmonary vascular hemodynamics in pulmonary hypertension. J Cardiac Failure,2005,11:425-431.
3. Yap LB, Ashrafian H, Mukerjee D, et al. The natriuretic peptides and their role in disorders of right heart dysfunction and pulmonary hypertension. Clin Biochem,2004,37:847-856.
4. Holmes SJ, Espiner EA, Richards AM, et al. Renal, endocrine, and hemodynamic effects of human brain natriuretic peptide in normal man. J Clin Endocrinol Metab,1993,76:91-96.
5. Cargill RI, Lipworth BJ. Atrial natriuretic peptide and brain natriuretic peptide in cor pulmonale. Hemodynamic and endocrine effects. Chest,1996,110:1220-1225.
6. Bhat G, Costea A. Reversibility of medically unresponsive pulmonary hypertension with nesiritide in a cardiac transplant recipient. ASAIO J,2003,49:608-610.
7. Daniel J, Lenihan Mary T, Vooletich J, et al. Nesiritide may be valuable in the evaluation and treatment of secondary pulmonary hypertension. J Card Fail,2005,11(6 Suppl):S159.
8. Chen T, Jiang N, Wang L, et al. The significance of natriuretic peptide in treatment of pulmonary hypertension after mitral valve replacement. J Thorac Cardiovasc Surg,2014,147:1362-1367.
9. Michaels AD, Chatterjee K, De Marco T. Effects of intravenous nesiritide on pulmonary vascular hemodynamics in pulmonary hypertension. J Card Fail,2005,11:425-431.
10. Klinger JR, Thaker S, Houtchens J, et al. Pulmonary hemodynamic responses to brain natriuretic peptide and sildenafil in patients with pulmonary arterial hypertension. Chest,2006,129:417-425.
11. Khush KK, De Marco T, Vakharia KT, et al. Nesiritide acutely increases pulmonary and systemic levels of nitric oxide in patients with pulmonary hypertension. J Card Fail,2006,12:507-513.
12. Stevens TL, Burnett JC Jr, Kinoshita M, et al. A functional role for endogenous atrial natriuretic peptide in a canine model of early left ventricular dysfunction. J Clin Invest,1995,95:1101-1108.
13. Sackner-Bernstein JD, Skopicki HA, Aaronson KD. Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure. Circulation,2005,111:1487-1491.
14. Chen HH, Lainchbury JG, Harty GJ, et al. Maximizing the natriuretic peptide system in experimental heart failure:subcutaneous brain natriuretic peptide and acute vasopeptidase inhibition. Circulation,2002,105:999-1003.
15. Klinger JR, Petit RD, Warburton RR, et al. Neutral endopeptidase inhibition attenuates development of hypoxic pulmonary hypertension in rats. J Appl Physiol,1993,75:1615-1623.

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Reversibility of Medically Unresponsive Idiopathic Pulmonary Artery Hypertension with Nesiritide:One Case Report and Literature Review

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