Sildenafil, as it is called by its more anonymous chemical name, may have the power to save babies. Chronic pulmonary hypertension is virtually a death sentence in newborn babies. It can begin with a heart defect, or for reasons that are not well explained; but when the blood pressure rises inside the lungs and stays that way, there is often little that can be done.
But a few small studies have recently suggested that babies with deadly pulmonary hypertension may respond with good success to Sildenafil.
In the case of 6-month-old Hartley Wilson, Don Moore, M.D., a pediatric cardiologist at Vanderbilt Children's Hospital, had to make a difficult decision. Shortly after birth, Hartley had emergency surgery to correct a heart defect known as total anomalous pulmonary venous return. He remained in the hospital for the next two months.
"After a brief stay at home, he was readmitted to the hospital," Moore said. "The blood pressure in his lungs was five or six times normal and the right side of his heart was struggling to function," recalled Moore.
Time was ticking away from the moment then-3-month-old Hartley returned to Vanderbilt Children's Hospital. Very high pressures, like his can cause heart failure and death. Hartley was rushed to cardiac catheterization in order to get an accurate reading of the pressure in his lungs.
Even after a successful heart surgery, like Hartley's, problems may develop that result in pulmonary hypertension. It could be vessels that are prone to clotting or scarring after surgery, or vessels throughout the lungs that have a tendency to tighten, reducing the freedom of blood flow from the lungs back to the heart.
During the procedure, Moore tried a drug well known to reduce deadly pulmonary hypertension in infants: an inhaled drug called nitric oxide.