Does prostacyclin enhance the selective pulmonary vasodilator effect of oxygen in children with congenital heart disease?

Bush, Andrew; Busst, C M; Booth, Karen; Knight, W B; Shinebourne, E A

doi:10.1161/01.cir.74.1.135

Cited by 51 publications

(12 citation statements)

References 46 publications

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“…Our observations do not support those of other authors that oxygen has a selective pulmonary vasodilator effect in children with congenital heart disease and pulmonary hypertension [11,12].…”

Section: Discussioncontrasting

confidence: 99%

Long-term hemodynamic effects of nifedipine on congenital heart disease with eisenmenger's mechanism in children

Wimmer

Schlemmer

1992

Cardiovasc Drug Ther

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The hemodynamic effect of long-term nifedipine medication was studied in 10 children, 3-12 years of age, five with ventricular septal defect and five with complete atrioventricular septal defect; all had Eisenmenger's reaction, seven also had Down's syndrome. They underwent heart catheterization prior to and during 1-4 years of nifedipine therapy. Fick's principle was used to calculate the ratio of pulmonary arterial pressure to aortic pressure (PAP/PAO), the ratio of pulmonary flow to aortic flow (QP/QS), as well as the ratio of pulmonary vascular resistance to aortic vascular resistance (RP/RS). In the seven children under 8.8 years, nifedipine caused a significant drop in PAP/PAO (p less than 0.004), a slight increase in arterial O2 saturation, a significant increase in QP/QS (p less than 0.02), and a decrease in RP/RS (p less than 0.02). The nifedipine effect was age related. On nifedipine, breathing oxygen resulted in, independent of age, a significant increase in QP/QS (p less than 0.003) and a significant decrease in PAP/PAO (p less than 0.04) and in RP/RS (p less than 0.003). Direct O2 consumption measurements before and during oxygen breathing in six patients demonstrated no significant change in RP, RS, QP, or QS indices. Nifedipine had a relaxing effect on the pulmonary vascular bed, especially in the younger child with Eisenmenger's mechanism. On nifedipine therapy, O2 produced a more complex hemodynamic reaction that was not restricted to the pulmonary circulation alone.

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Section: Discussioncontrasting

confidence: 99%

Long-term hemodynamic effects of nifedipine on congenital heart disease with eisenmenger's mechanism in children

Wimmer

Schlemmer

1992

Cardiovasc Drug Ther

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“…'5 16 Briefly, the infants were studied while they were anaesthetised, paralysed, and ventilated. We measured cardiac output by the direct Fick principle, and calculated pulmonary vascular resistance, wasted ventilation (alveolar dead space), and wasted perfusion (anatomical shunt).…”

Section: Physiological Studiesmentioning

confidence: 99%

Changes in pulmonary circulation in severe bronchopulmonary dysplasia.

Bush

Busst

Knight

et al. 1990

Archives of Disease in Childhood

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Eight patients with severe bronchopulmonary dysplasia underwent cardiac catheterisation. Seven had a pulmonary vascular resistance >3 mm Hg.l-' min.m2 (mean 8-9, range 2-2-13-8). All had raised intrapulmonary shunts (mean 25-6%, range 5-4-50%, normal <5%). Two had a high alveolar dead space, and two had unsuspected congenital heart disease. Epoprostenol (prostacyclin), but not 100% oxygen, caused a significant fail in pulmonary vascular resistance. Death was associated with a high pulmonary vascular resistance and a high shunt. Morphometric studies in three cases showed normal numbers of airways, but increased thickness of bronchial muscle. The numbers of alveoli were reduced and the wails thickened. There was increased medial thickness in small pulmonary arteries with distal extension of muscle. In the oldest child some vessels were obliterated by fibrosis. We speculate that measurements of pulmonary vascular resistance and shunt may have prognostic value; that a trial of pulmonary vasodilators other than oxygen might be worthwhile in patients with poor prognosis; and that abnormalities of the pulmonary circulation contribute to the difficulties of managing patients with bronchopulmonary dysplasia.

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“…In patients for whom the only surgical option is lung or heart lung transplantation, vasodilator testing may be useful to identify those requiring urgent operation. Several vasodilating agents, such as oxygen, tolazoline, and prostacyclin, have been used to test the vasoreactivity of the pulmonary circulation 3. These drugs, however, are not selective pulmonary vasodilators, thereby making interpretation difficult.…”

mentioning

confidence: 99%