VentaProst (epoprostenol inhalation) / Aerogen Pharma - LARVOL DELTA

Anesthetic Management of Acute Right Ventricular Failure in Severe Pulmonary Hypertension Post- General Anesthesia (ASA 2026) - "Inhaled epoprostenol played a key role as it reduced pulmonary vascular resistance, improved ventilation and perfusion matching without exacerbating systemic hypotension. Advanced hemodynamic monitoring led the team to abort the operation and stabilize the patient in the ICU."

Cardiovascular • Hypotension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Treatment of Refractory Hypoxia on One Lung Ventilation with Inhaled Epoprostenol and Milrinone (ASA 2026) - "After resuming two-lung ventilation, oxygenation normalized. The patient was extubated, transferred to PACU in stable condition, and discharged home on postoperative day two."

Squamous Cell Carcinoma

Utilizing THAM and Inhaled Epoprostenol for Management of Iatrogenic RV Perforation and Severe Acidemia in a Morbidly Obese Patient Post-CABG (ASA 2026) - "Following emergent re-sternotomy and repair, the patient's status dramatically improved (pH 7.25, PaO2 164, PaCO2 39.6). This case demonstrates the efficacy of non-CO2-generating buffers and inhaled vasodilators in salvaging catastrophic complications in morbidly obese patients with limited ventilatory reserve."

Clinical • Obesity

When Inhaled Nitric Oxide Fails: Inhaled Epoprostenol for Refractory Right Ventricular Failure After Pulmonary Embolism and Cardiac Arrest (ASA 2026) - "Inhaled epoprostenol was initiated, resulting in improved oxygenation and reduced vasopressor requirements, enabling ICU discharge. This case demonstrates inhaled epoprostenol as an effective rescue pulmonary vasodilator when nitric oxide is contraindicated."

Cardiovascular • CNS Disorders • Hematological Disorders • Infectious Disease • Orthopedics • Pulmonary Embolism • Respiratory Diseases

When Separation Fails: Atrioventricular Groove Hematoma Causing Coronary Compression and Catastrophic Circulatory Collapse After Robotic Mitral Valve Repair (ASA 2026) - "Emergent coronary artery bypass grafting was undertaken; however, the patient developed refractory biventricular failure upon weaning off bypass despite vasopressors, inotropes, and inhaled epoprostenol. Mechanical support with veno-arterial extracorporeal membrane oxygenation and Impella was initiated. This case underscores the importance of early echocardiographic recognition of atrioventricular groove hematoma as a rare but fatal cause of postcardiotomy shock."

Cardiovascular

Anaphylactic Shock to Rocuronium versus Thymoglobulin Complicated by Severe ARDS in a Patient Undergoing Renal Transplant (ASA 2026) - "He was he admitted to the ICU post-operatively, where he was treated with an epinephrine infusion. His ICU course was complicated by ARDS, and he was treated with prone positioning, neuromuscular blockade with cisatracurium, and inhaled epoprostenol. He was extubated on post-operative day 11 and discharged from the hospital on post-operative day 23."

Clinical • Cardiovascular • Hypertension • Hypotension • Nephrology • Renal Disease • Transplantation

Multi-Modal Approach to Extracorporeal Life Support (ECLS) for Evolving Multifactorial Shock State (ASA 2026) - "Given relatively stable hemodynamics but persistent hypoxemia despite optimal PEEP, paralysis, and inhaled epoprostenol, the patient underwent TEE-guided VV ECMO cannulation...A femoral arterial cannula was inserted and the circuit was reconfigured for V-AV ECMO. Subsequent pericardiocentesis drained 400cc of blood with notable improvement in hemodynamics."

Clinical • Acute Respiratory Distress Syndrome • Cardiovascular • Hypotension • Infectious Disease • Influenza • Respiratory Diseases

MAC for D&E in Pregnant Patient with Life Threatening Pulmonary Hypertension (ASA 2026) - "Surgery is performed under MAC with versed and propofol, continuation of norepinephrine, IV epoprostenol and inhaled nitric oxide, A-line monitoring, and CT surgery/ECMO on standby. This case demonstrates anesthesia challenges associated with life threatening pulmonary hypertension in the setting of pregnancy."

Clinical • Cardiovascular • Genetic Disorders • Lung Cancer • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Septic Shock

Severe Pulmonary Hypertension Due to Undiagnosed Congenital Heart Disease Presenting in Late Pregnancy (PHA 2026) - "Right heart catheterization showed pulmonary artery pressures of 104/61 mmHg (mean 84 mmHg), normal pulmonary capillary wedge pressure (6 mmHg), Qp:Qs 2.1, preserved cardiac index, and pulmonary vascular resistance of 4.0 Wood units The patient was initiated on inhaled Epoprostenol via high-flow nasal cannula and intravenous Treprostinil starting at 2 ng/kg/min with daily up-titration to 8 ng/kg/min...Postpartum, she was transitioned to oral triple therapy with Sildenafil, Ambrisentan, and Selexipag (600 μg twice daily) and discharged in stable condition... This case highlights late-pregnancy presentation of severe PH due to previously unrecognized CHD with systemic-to-pulmonary shunting. Rapid hemodynamic assessment, early initiation of parenteral prostacyclin therapy, and coordinated multidisciplinary delivery planning enabled favorable maternal and fetal outcomes. Early consideration of occult CHD is essential in pregnant patients presenting with unexplained..."

Cardiovascular • Congestive Heart Failure • Heart Failure • Obstetrics • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Short-term physical compatibility of milrinone and epoprostenol for inhalation in cardiac surgery. (PubMed, Can J Anaesth) - No abstract available

Journal • Cardiovascular

Management of Pulmonary Hypertension Due to Atrial Septal Defect and Acute Pulmonary Embolism with VA-ECMO (ISHLT 2026) - "She received diuretics, inhaled epoprostenol, and anti-coagulation, and was extubated day 9...IV treprostinil was started up to 20 ng/kg/min allowing for ECMO decannulation on day 25.She was transitioned to oral PH therapy (macitentan/sildenafil) with ASD closure deferred due to high PVR...She is now off oxygen, working, on combination pill macitentan/tadalafil.Summary VA-ECMO is a viable strategy for PH patients who develop refractory RV failure, as a bridge to lung transplantation or initiation of PH therapies. Careful patient selection and multidisciplinary management is essential."

Cardiovascular • Hypertension • Hypotension • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases • Thrombosis

A retrospective pilot crossover study of protocolized transition from inhaled nitric oxide to inhaled epoprostenol in adult cardiothoracic surgery. (PubMed, JHLT Open) - "The findings support iEPO as a cost-conscious alternative to iNO in the postoperative setting, with preserved hemodynamic stability and minimal changes in oxygenation. These results contribute to the growing evidence base for implementing standardized iPVD protocols in real-world practice."

Journal • Retrospective data • Cardiovascular • Critical care • Heart Failure • Hypertension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Breathing Easy: Cases of Transitioning Between Inhaled Prostacyclin Products (SCCM 2026) - "Once optimized, patients are often transitioned back to maintenance medications, however there is minimal to no evidence to guide the transition from nebulized epoprostenol to inhaled treprostinil products.Description: We present 3 patients with PH who were successfully transitioned from nebulized epoprostenol to inhaled treprostinil DPI (Tyvaso DPI®) or nebulizer (Tyvaso®) using multiple approaches. Pulmonologists specialized in PH and pharmacists are uniquely suited to develop treatment plans for transitioning patients between these high-risk medications. Further research and discussion regarding transitions between these inhaled agents would be beneficial to inform patient specific strategies in the future."

Clinical • Cardiovascular • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Outcome of Pediatric Pulmonary Hypertension Patients Requiring ECMO (SCCM 2026) - "100% (31/31) of patients received at least one PAH therapy prior to and during ECMO [31/31 (100%) inhaled nitric oxide or inhaled epoprostenol; 26/31 (84%) sildenafil, tadalafil or riociugat; 18/31 (58%) macitentan, ambrisentan or bosentan; 8/31(26%) selexipag; 10/31(32%) treprostinil. Pediatric PAH is a complex disease due to varied etiologies often requiring multiple medications to effectively manage. Certain subpopulations such as those with single ventricle CHD have higher mortality especially when requiring ECMO. Further study is necessary to determine if earlier identification and management of PAH patients prior to ECMO can improve survival and decrease need for mechanical circulatory support in this high-risk population."

Clinical • Cardiovascular • Heart Failure • Hematological Disorders • Infectious Disease • Pediatrics • Pneumonia • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases

Inhaled Epoprostenol for Refractory Hypoxemia in an Adult Fontan Patient With HLHS: A Case Report (SCCM 2026) - "This case demonstrates the utility of epoprostenol as a rescue strategy for refractory hypoxemia in adults with complex congenital heart disease. Recognition of unique physiologic interactions in this population is crucial for individualized management in the ICU."

Case report • Clinical • Cardiovascular • Cognitive Disorders • Heart Failure • Pulmonary Disease • Respiratory Diseases

Evaluation of Inhaled Epoprostenol Use in the Intensive Care Unit (SCCM 2026) - "Several patients received iEPO for an unapproved indication and many were continued on iEPO despite non-response. This warrants re-evaluation of our approved indications and education regarding iEPO use to reduce time and resources associated with inappropriate use."

Acute Respiratory Distress Syndrome • Cardiovascular • Critical care • Heart Failure • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Fat Embolism Syndrome and Cardiopulmonary Arrest Survival Following Elective Posterior Spinal Fusion (SCCM 2026) - "Max-dose inhaled epoprostenol, antibiotics, inotropes, and diuretics were started...Our case report describes a patient with severe FES and cardiopulmonary collapse following a similarly executed spinal fusion who survived without MCS. This case highlights that, although rare, severe FES is a potential complication of posterior spinal fusions and survival is possible."

Atrial Fibrillation • Cardiovascular • Hematological Disorders • Hepatology • Hypotension • Liver Failure • Musculoskeletal Diseases • Orthopedics • Pulmonary Embolism • Respiratory Diseases • Thrombocytopenia

IS IT GROUP 3 OR GROUP 1 IN DISGUISE? AN UNTIMELY DIAGNOSIS OF PULMONARY ARTERIAL HYPERTENSION (ACC 2026) - "Despite inhaled epoprostenol, vasopressors, and inotropes, the patient died from right heart failure... Do not assume Group 3 PH in COPD when findings are out of proportion. Obtain a RHC to classify the etiology of PH. Screen for autoimmune causes in suspected PAH and refer early to a PH center."

Cardiovascular • Chronic Obstructive Pulmonary Disease • Congestive Heart Failure • Heart Failure • Immunology • Peripheral Arterial Disease • Pulmonary Arterial Hypertension • Respiratory Diseases • Scleroderma • Systemic Sclerosis

PULMONARY ARTERIAL HYPERTENSION MIMIC: PULMONARY TUMOR THROMBOTIC MICROANGIOPATHY IN METASTATIC ENDOMETRIAL CARCINOMA (ACC 2026) - "Case: A 58-year-old female with diabetes, hypertension, and prior breast cancer on tamoxifen presented with weight loss and post-menopausal bleeding...She received norepinephrine, vasopressin, inhaled epoprostenol, and IV prostacycline but deteriorated and expired... Early suspicion and diagnosis of PTTM are essential to guide care, though prognosis remains poor."

Metastases • Breast Cancer • Cardiovascular • Diabetes • Endometrial Adenocarcinoma • Endometrial Cancer • Gynecology • Hypertension • Hypotension • Lung Cancer • Metabolic Disorders • Oncology • Pulmonary Arterial Hypertension • Respiratory Diseases • Solid Tumor

ACUTE RV SHOCK AFTER TRANSCATHETER TRICUSPID VALVE REPLACEMENT (ACC 2026) - "Inhaled epoprostenol (50 ng/kg/min) was added to decrease PVR...Intermittent IV bumetanide was used to achieve a CVP of 10-12 mmHg... The patient improved clinically and hemodynamically. After 36 hours of hemodynamic stability, vasoactive agents were weaned in sequence—vasopressin, then dobutamine, followed by epoprostenol. All vasoactives were off by post-procedure day 4 and the patient was discharged by day 6."

Cardiovascular • Metabolic Disorders • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Use of Inhaled Epoprostenol to Facilitate Ventilator Weaning in Scleroderma-Associated Group 1 Pulmonary Arterial Hypertension and Acute Right Heart Failure (ATS 2026) - No abstract available

Cardiovascular • Congestive Heart Failure • Heart Failure • Immunology • Pulmonary Arterial Hypertension • Respiratory Diseases • Scleroderma • Systemic Sclerosis

Substantial Cost Savings: A Multi-Center Cost Analysis of Nitric Oxide and Epoprostenol Usage in Neonatal Congenital Heart Disease (STS 2026) - "Conclusions In neonatal congenital heart cases, NO is used almost universally despite little clinical difference to inhaled epoprostenol. Because NO is around 32 times more expensive than epoprostenol, strategic implementation of epoprostenol as an alternative to NO could yield substantial cost savings while maintaining therapeutic efficacy. Table Image"

Clinical • Cost-analysis • HEOR • Cardiovascular • Heart Failure

Between a Rock and a Hard Place: Hip Fracture Repair in an Elderly Patient with Severe Cardiac Comorbidities and Limited Options: A Problem-Based Learning Discussion. (PubMed, A A Pract) - "A tailored management approach included peripheral nerve blocks, intraoperative transesophageal echocardiographic monitoring, goal-directed hemodynamic support, and management of acute RV decompensation with intratracheal milrinone and inhaled epoprostenol. It presents strategies for high-risk geriatric trauma patients, individualized anesthetic planning, and the role of pulmonary vasodilators."

Journal • Anesthesia • Cardiovascular • Cognitive Disorders • Geriatric Disorders • Heart Failure • Hypertension • Musculoskeletal Diseases • Orthopedics • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

One and Done: Simplifying Inhaled Epoprostenol with Single-Syringe Workflow (ASHP 2025) - No abstract available

Impact of a Weaning Protocol on Duration of Inhaled Epoprostenol Therapy in Acute Respiratory Distress Syndrome: A Retrospective Review (ASHP 2025) - No abstract available

Retrospective data • Review • Acute Respiratory Distress Syndrome • Respiratory Diseases