Acute venodilation properties of low-dose intravenous nitroglycerine in pulmonary veno-occlusive disease: a case report

Background The use of pulmonary vasodilators for pulmonary arterial hypertension (PAH) has led to a favourable prognosis. In contrast, pulmonary veno-occlusive disease (PVOD) is characterized by the possibility of severe pulmonary oedema after specific PAH therapy. Pulmonary oedema presumably develops in association with pulmonary arterial vasodilation without concomitant pulmonary venodilation. The venous circulation maximally dilates with small amounts of nitroglycerine. Case summary A 59-year-old woman with advanced PVOD was referred to our hospital. We performed a right heart catheterization after administering combination therapy with selexipag and macitentan, and intravenous nitroglycerine at 0.2 and 0.4 & mu;g/kg/min decreased pulmonary arterial wedge pressure (PAWP) and mean pulmonary arterial pressure (PAP) to minimal levels. The final dose of 1 & mu;g/kg/min yielded an & SIM;20% decrease in mean PAP and pulmonary vascular resistance (PVR). Discussion Here, we described the acute effect of intravenous nitroglycerine on PAWP and PVR in a patient with PVOD. This case highlights the venodilation response even in advanced PVOD, suggesting the importance of further research into selective venous dilators as potent therapy.