NITRIC-OXIDE IS SUPERIOR TO PROSTACYCLIN FOR PULMONARY-HYPERTENSION AFTER CARDIAC OPERATIONS

Background. Severe pulmonary hypertension is still a cause of morbidit y and mortality in children after cardiac operations. The objective of this study was to compare the vasodilator properties of inhaled nitri c oxide, a novel pulmonary vasodilator, and intravenous prostacyclin i n the treatment of severe postoperative pulmonary hypertension. Method s. Thirteen children (aged 3 days to 12 months) with severe pulmonary hypertension after cardiac operations were given inhaled nitric oxide (20 ppm x 10 minutes) acid intravenous prostacyclin (20 ng.kg(-1).min( -1) x 10 minutes) in a prospective, randomized cross-over study. Resul ts. Both nitric oxide and prostacyclin resulted in a reduction in pulm onary arterial pressure, although the mean pulmonary arterial pressure was significantly lower during nitric oxide therapy (28.5 +/- 2.9 mm Hg) than during prostacyclin therapy (35.4 +/- 2.1 mm Hg; p < 0.05). T he mean pulmonary to systemic arterial pressure ratio was also signifi cantly lower during nitric oxide than prostacylin administration (0.46 +/- 0.04 versus 0.68 +/- 0.05; p < 0.01), due mainly to only prostacy clin lowering systemic blood pressure. Conclusions. Inhaled nitric oxi de was a more effective and selective pulmonary vasodilator than prost acyclin and should be considered as the preferred treatment for severe postoperative pulmonary hypertension.