Rd. Curran et al., INHALED NITRIC-OXIDE FOR CHILDREN WITH CONGENITAL HEART-DISEASE AND PULMONARY-HYPERTENSION, The Annals of thoracic surgery, 60(6), 1995, pp. 1765-1771
Background. Endothelium-derived nitric oxide (NO) is a potent vasodila
tor and a major mediator of pulmonary vascular tone. Methods. Five inf
ants underwent a trial of inhaled NO with hemodynamic monitoring in th
e operating room after atrioventricular canal repair. An additional 15
patients with congenital heart disease and refractory pulmonary hyper
tension were treated with inhaled NO for 1 day to 10 days postoperativ
ely. Results. In the 5 infants with atrioventricular canal, corrective
surgical intervention and conventional therapy (hyperventilation, ins
pired oxygen fraction of 0.80, and inotropic agents) lowered mean pulm
onary artery pressure from 49.5 +/- 10.5 to 20.0 +/- 2.2 mm Hg (p < 0.
001). Adding inhaled NO further decreased mean pulmonary artery pressu
re to 18.0 +/- 2.8 mm Hg (p = not significant). Inhaled NO had no effe
ct on ventricular function curves (inflow occlusion) in this group. In
the 15 patients with refractory postoperative pulmonary hypertension,
11 had a favorable response to inhaled NO, with a decrease in mean pu
lmonary artery pressure from 30.9 +/- 5.8 to 23.1 +/- 5.4 mm Hg (p < 0
.01) in 8 patients with pulmonary artery catheters. Conclusions. These
studies demonstrate that inhaled NO has minimal beneficial effect on
pulmonary artery pressure or cardiac output in infants after repair of
atrioventricular canal. Inhaled NO is effective in decreasing PAP pos
toperatively in select patients with congenital heart disease and pulm
onary hypertension refractory to conventional therapeutic modalities.