Inhaled nitric oxide differentiates pulmonary vasospasm from vascular obstruction after surgery for congenital heart disease

Beghetti, Maurice; Morris, Kevin; Cox, Patrick; Bohn, Desmond; Adatia, Ian

doi:10.1007/s001340051022

Cited by 25 publications

(12 citation statements)

References 15 publications

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“…It produces potent, selective pulmonary vasodilation that is independent of endothelial cell function. Therefore, it has been employed in the preoperative assessment of pulmonary hypertension, the perioperative management of pulmonary hypertension, and the postoperative assessment of pulmonary hypertension (2,4,5). Although many studies demonstrate a clear benefit in patient outcome with inhaled NO use, several safety concerns remain, including unpredictable and nonsustained responses to inhaled NO and a clinically significant rapid increase in pulmonary vascular resistance upon its acute withdrawal (1,(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Endothelial alterations during inhaled NO in lambs with pulmonary hypertension: implications for rebound hypertension

Ross¹,

Oishi²,

Azakie³

et al. 2005

American Journal of Physiology-Lung Cellular and Molecular Phys

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Clinically significant increases in pulmonary vascular resistance (PVR) have been noted upon acute withdrawal of inhaled nitric oxide (iNO). Previous studies in the normal pulmonary circulation demonstrate that iNO increases endothelin-1 (ET-1) levels and decreases endogenous nitric oxide synthase (NOS) activity, implicating an endothelial etiology for the increase in resistance upon iNO withdrawal. However, the effect of iNO on endogenous endothelial function in the clinically relevant pulmonary hypertensive circulation is unknown. The objective of this study was to determine the effects of iNO on endogenous NO-cGMP and ET-1 signaling in lambs with preexisting pulmonary hypertension secondary to increased pulmonary blood flow. Eight fetal lambs underwent in utero placement of an aortopulmonary vascular graft (shunt lambs). After delivery (4 wk), the shunt lambs were mechanically ventilated with iNO (40 ppm) for 24 h. After 24 h of inhaled NO, plasma ET-1 levels increased by 34.8% independently of changes in protein levels (P < 0.05). Contrary to findings in normal lambs, total NOS activity did not decrease during iNO. In fact, Western blot analysis demonstrated that tissue endothelial NOS protein levels decreased by 43% such that NOS activity relative to protein levels actually increased during iNO (P < 0.05). In addition, the beta-subunit of soluble guanylate cyclase decreased by 70%, whereas phosphodiesterase 5 levels were unchanged (P < 0.05). Withdrawal of iNO was associated with an acute increase in PVR, which exceeded baseline PVR by 45%, and a decrease in cGMP concentrations to levels that were below baseline. These data suggest that the endothelial response to iNO and the potential mechanisms of rebound pulmonary hypertension are dependent upon the underlying pulmonary vasculature.

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Section: Discussionmentioning

confidence: 99%

Endothelial alterations during inhaled NO in lambs with pulmonary hypertension: implications for rebound hypertension

Ross¹,

Oishi²,

Azakie³

et al. 2005

American Journal of Physiology-Lung Cellular and Molecular Phys

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“…During a previous study we noticed that lung transplant recipients when studied immediately following surgery exhale measurable amounts of NO that are higher than subjects following a similar degree of lung hypoperfusion for coronary artery bypass surgery [18]. Since lung transplant recipients have been reported to display marked pulmonary vascular sensitivity to inhaled NO [19] with inhaled NO being used to selectively reverse vasospasm following congenital heart surgery [20] we also studied lung transplant patients.…”

Section: Introductionmentioning

confidence: 99%

Nitric oxide contamination of hospital compressed air improves gas exchange in patients with acute lung injury

et al. 2002

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“…However, persistent pulmonary hypertension with reactive pulmonary vasoconstriction after the procedure may be a rare cause of cyanosis in PAIVS following RPVV. Inhaled nitric oxide has been proved to be a potent selective pulmonary vasodilator, which is effective in the management of postoperative pulmonary hypertension in patients with congenital heart disease 22-26. However, in spite of routine application in the clinical practice, nitric oxide inhalation has rarely been documented in the English literature in the postoperative care of patients with PAIVS treated by RPVV.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in Neonates with Pulmonary Atresia and Intact Ventricular Septum Underwent Pulmonary Valvulotomy and Valvuloplasty Using a Flexible 2-French Radiofrequency Catheter

et al. 2009

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Previously, surgical repair for neonates with pulmonary atresia and intact ventricular septum (PAIVS) involved: either 1) a palliative systemic-to-pulmonary shunt, or 2) a corrective pulmonary valvulotomy together with reconstruction of the right ventricular outflow tract.1 However, the mortality and the morbidity remained high after surgery, especially in those with severe hypoplastic right ventricles with or without infundibulum, non-confluent pulmonary arteries, ventriculocoronary communication (VCC), and right ventricle-dependent coronary circulation (RVDCC).2 Recently, transcatheter radiofrequency pulmonary valvulotomy and valvuloplasty (RPVV) emerged as a promising alternative to surgical pulmonary valvulotomy for PAIVS in patients with favorable morphology of the right ventricle, the tricuspid valve, and the pulmonary valve. Purpose : Outcomes in 6 neonates with pulmonary atresia and intact ventricular septum (PAIVS) undergoing radiofrequency pulmonary valvulotomy and valvuloplasty (RPVV) were reported to identify the factors favorable for RPVV as the treatment of choice. Materials and Methods: From May 2000 to January 2008, 6 patients with PAIVS were included in this retrospective study. They were aged 1 day to 90 days old. Study modalities included review of recordings of presentations and profiles of chest radiography, electrocardiography, echocardiography, and cardiac catheterization with angiography. Hemodynamic profiles from the echocardiography and the cardiac catheterization were analyzed. Results: Echocardiography showed severe tricuspid regurgitation, membranous atresia of the pulmonary valve, intact ventricular septum, patent ductus arteriosus, and hypoplastic right ventricle in 6 patients. The pulmonary valve annulus were 4.2 to 6.9 mm in diameters, and those of the tricuspid valve were 7.1 to 10.1 mm. Elevated serum level of cardiac enzymes were found in 1 patient with ventriculocoronary communication (VCC). At cardiac catheterization, the ratio of systolic pressure of the right ventricle to that of the left ventricle ranged from 1.43 to 2.33 before RPVV, and from 0.54 to 1.15 after RPVV (p=0.027). The pressure gradients ranged from 76 to 136 mmHg before RPVV, and from 15 to 39 mmHg after RPVV (p=0.028). The echocardiographic gradients ranged from 16 to 32 mmHg within 24 hours after RPVV, and from 15 to 50 mmHg at the follow-ups. Conclusion: RPVV can be a treatment of choice for neonates with PAIVS, if there is patent infundibulum, no right-ventricular dependent coronary circulation, and adequate tricuspid valve and pulmonary valve.

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Inhaled nitric oxide differentiates pulmonary vasospasm from vascular obstruction after surgery for congenital heart disease

Cited by 25 publications

References 15 publications

Endothelial alterations during inhaled NO in lambs with pulmonary hypertension: implications for rebound hypertension

Endothelial alterations during inhaled NO in lambs with pulmonary hypertension: implications for rebound hypertension

Nitric oxide contamination of hospital compressed air improves gas exchange in patients with acute lung injury

Outcomes in Neonates with Pulmonary Atresia and Intact Ventricular Septum Underwent Pulmonary Valvulotomy and Valvuloplasty Using a Flexible 2-French Radiofrequency Catheter

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