Randomized controlled study of inhaled nitric oxide after operation for congenital heart disease

Background. Inhaled nitric oxide selectively decreases pulmonary vascular r esistance. This study was performed to determine whether inhaled nitric oxi de decreases the incidence of pulmonary hypertensive crises after correctiv e procedures for congenital heart disease. Methods. Patients with a systolic pulmonary arterial pressure of 50% or mor e of the systolic systemic arterial pressure during the early postoperative period were randomized to receive 20 parts per million inhaled nitric oxid e (n = 20) or conventional therapy alone (n = 20). Acute hemodynamic and bl ood gas measurements were performed at the onset of therapy. The efficacy o f sustained therapy was determined by comparing the number of patients in e ach group who experienced a pulmonary hypertensive crisis. Results. In comparison to controls, there were no significant differences i n the baseline and 1-hour measurements of patients who were treated with ni tric oxide. Four patients in the control group and 3 patients in the nitric oxide group experienced a pulmonary hypertensive crisis. Conclusions. Nitric oxide did not substantially improve pulmonary hemodynam ics and gas exchange immediately after operation for congenital heart disea se. Nitric oxide also failed to significantly decrease the incidence of pul monary hypertensive crises. (C) 2000 by The Society of Thoracic Surgeons.