INHALED NITRIC-OXIDE IN PATIENTS WITH CRITICAL PULMONARY PERFUSION AFTER FONTAN-TYPE PROCEDURES AND BIDIRECTIONAL GLENN ANASTOMOSIS

Objective: The aim of this study was to evaluate the effects of inhale d nitric oxide in patients with critical pulmonary perfusion after Fon tan-type procedures and bidirectional Glenn anastomosis. Methods: Inha led nitric oxide (mean 4.1 +/- 0.7 ppm, 1.5 to 10 ppm) was administere d in 13 patients (mean age 5.6 +/- 1.6 years, 1.5 to 17 years) with cr itical pulmonary perfusion (central venous pressure >20 mm Hg or trans pulmonary pressure gradient >10 mm Hg) in the early postoperative peri od after total cavopulmonary connection (n = 9) or after bidirectional Glenn anastomosis (n = 4). Results: In patients after total cavopulmo nary connection inhaled nitric oxide therapy decreased central venous pressure by 15.3% +/- 1.4% (p = 0.0001) and transpulmonary pressure gr adient by 42% +/- 8% (p = 0.0008) and increased mean systemic arterial and left atrial pressures by 12% +/- 3.6% (p = 0.011) and 28% +/- 8% (p = 0.007), respectively, Arterial and venous oxygen saturations impr oved by 8.2% +/- 1% (p = 0.005) and 14% +/- 4.3% (p = 0.03), respectiv ely, In patients after bidirectional Glenn anastomosis inhaled nitric oxide therapy resulted in a decrease of central venous pressure by 22% +/- 1% and of the transpulmonary pressure gradient by 55% +/- 6% and improved arterial and venous oxygen saturations by 37% +/- 29% and 11% +/- 3%, respectively, Mean systemic arterial and left atrial pressure s remained nearly unchanged, No toxic side effect was observed in any patient. Conclusion: Inhaled nitric or;ide may play an important role in the management of transient critical pulmonary perfusion caused by reactive elevated pulmonary vascular resistance in the early postopera tive period after Fontan-type operations and bidirectional Glenn anast omosis.