Inhaled Milrinone in Weaning from Cardiopulmonary Bypass: A Case Study.

Abstract

Separation from cardiopulmonary bypass (CPB) is a critical phase of cardiac surgery, particularly in patients with pulmonary hypertension and right heart failure. Milrinone, a phosphodiesterase inhibitor, is often used to support right ventricular function. While intravenous milrinone improves contractility and reduces pulmonary vascular resistance, its systemic vasodilatory effects may exacerbate hypotension. Inhaled milrinone has emerged as a targeted alternative, delivering pulmonary vasodilation without systemic hypotension. We report the case of a 55-year-old male undergoing aortic valve replacement and left atrial appendage ligation who successfully separated from CPB after receiving inhaled milrinone. Improvement in pulmonary artery pressures, central venous pressure, and cardiac output contributed to a smooth postoperative course.