Relief of Pulmonary Congestion by Sublingual Nitroglycerin in Patients with Mitral Valve Disease

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Acute pulmonary congestion may occur in patients with valvular heart disease despite vigorous medical therapy (digitalis-diuretic). Further increases in digitalis or diuretic dosage are then ineffective and may lead to problems of toxicity.1 Sublingual nitroglycerin (SNG) has been shown to be beneficial in emergency treatment of pulmonary edema due to myocardial infarction and valvular heart disease.24 In two patients with acute pulmonary congestion due to valvular heart disease (ruptured chorda tendenea and mitral stenosis) undergoing valve replacement, we used SNG to relieve pulmonary edema. In both patients, within 4 to 5 minutes after administration of SNG (0.8 mg), systolic pulmonary arterial pressure (PAP) and pulmonary capillary wedge pressure (PCWP) decreased significantly with concomitant improvement of clinical symptoms.

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