Inhaled nitric oxide for the postoperative management of pulmonary hypertension in infants and children with congenital heart disease

Bizzarro, Matthew J.; Gross, Ian

doi:10.1002/14651858.cd005055.pub2

Cited by 26 publications

(10 citation statements)

References 25 publications

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“…Although the exact effect of prophylactic iNO on the mortality of PAH-CHD patients has been a matter of debate, 23,24 iNO has been the standard therapy for the postoperative control of PAH and the prevention of PH crisis, as recommended by European guidelines from 2004. 25,26 However, the dosage and duration of iNO administration vary among institutions.…”

Section: Inhaled Nomentioning

confidence: 99%

Perioperative Pharmacological Management of Pulmonary Hypertensive Crisis during Congenital Heart Surgery

Brunner¹,

Perez²,

Richter³

et al. 2014

Pulm. circ.

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Pulmonary hypertensive crisis is an important cause of morbidity and mortality in patients with pulmonary arterial hypertension secondary to congenital heart disease (PAH-CHD) who require cardiac surgery. At present, prevention and management of perioperative pulmonary hypertensive crisis is aimed at optimizing cardiopulmonary interactions by targeting prostacyclin, endothelin, and nitric oxide signaling pathways within the pulmonary circulation with various pharmacological agents. This review is aimed at familiarizing the practitioner with the current pharmacological treatment for dealing with perioperative pulmonary hypertensive crisis in PAH-CHD patients. Given the life-threatening complications associated with pulmonary hypertensive crisis, proper perioperative planning can help anticipate cardiopulmonary complications and optimize surgical outcomes in this patient population.

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Section: Inhaled Nomentioning

confidence: 99%

Perioperative Pharmacological Management of Pulmonary Hypertensive Crisis during Congenital Heart Surgery

Brunner¹,

Perez²,

Richter³

et al. 2014

Pulm. circ.

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show abstract

“…This therapy improves hemodynamic and oxygenation profiles in multiple pediatric PH populations [236, 237] and lowers pulmonary arterial pressure, improves infant survival, and reduces the need for ECMO [238, 239]. However, approximately 30% of the infants do not respond to iNO.…”

Section: Current Treatment Strategiesmentioning

confidence: 99%

Antenatal Hypoxia and Pulmonary Vascular Function and Remodeling

Papamatheakis

Blood²,

Kim³

et al. 2013

CVP

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This review provides evidence that antenatal hypoxia, which represents a significant and worldwide problem, causes prenatal programming of the lung. A general overview of lung development is provided along with some background regarding transcriptional and signaling systems of the lung. The review illustrates that antenatal hypoxic stress can induce a continuum of responses depending on the species examined. Fetuses and newborns of certain species and specific human populations are well acclimated to antenatal hypoxia. However, antenatal hypoxia causes pulmonary vascular disease in fetuses and newborns of most mammalian species and humans. Disease can range from mild pulmonary hypertension, to severe vascular remodeling and dangerous elevations in pressure. The timing, length, and magnitude of the intrauterine hypoxic stress are important to disease development, however there is also a genetic-environmental relationship that is not yet completely understood. Determining the origins of pulmonary vascular remodeling and pulmonary hypertension and their associated effects is a challenging task, but is necessary in order to develop targeted therapies for pulmonary hypertension in the newborn due to antenatal hypoxia that can both treat the symptoms and curtail or reverse disease progression.

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“…In recent years, NO inhalation has become a widely used treatment for PPHN. This therapy improves hemodynamic and oxygenation profiles in multiple pediatric PH populations, 189,190 lowers pulmonary arterial pressure, improves infant survival, and reduces the need for ECMO. 191,192 However, as many as 50% of the infants do not respond to iNO, possibly because of either a dysfunction in sGC and PKG signaling or, in some cases, severe pulmonary hypoplasia with a markedly diminished pulmonary vascular bed and blood flow despite maximal vasodilation.…”

Section: Current Treatment Strategiesmentioning

confidence: 99%

Prenatal Programming of Pulmonary Hypertension Induced by Chronic Hypoxia or Ductal Ligation in Sheep

et al. 2013

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Pulmonary hypertension of the newborn is caused by a spectrum of functional and structural abnormalities of the cardiopulmonary circuit. The existence of multiple etiologies and an incomplete understanding of the mechanisms of disease progression have hindered the development of effective therapies. Animal models offer a means of gaining a better understanding of the fundamental basis of the disease. To that effect, a number of experimental animal models are being used to generate pulmonary hypertension in the fetus and newborn. In this review, we compare the mechanisms associated with pulmonary hypertension caused by two such models: in utero ligation of the ductus arteriosus and chronic perinatal hypoxia in sheep fetuses and newborns. In this manner, we make direct comparisons between ductal ligation and chronic hypoxia with respect to the associated mechanisms of disease, since multiple studies have been performed with both models in a single species. We present evidence that the mechanisms associated with pulmonary hypertension are dependent on the type of stress to which the fetus is subjected. Such an analysis allows for a more thorough evaluation of the disease etiology, which can help focus clinical treatments. The final part of the review provides a clinical appraisal of current treatment strategies and lays the foundation for developing individualized therapies that depend on the causative factors.

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Inhaled nitric oxide for the postoperative management of pulmonary hypertension in infants and children with congenital heart disease

Cited by 26 publications

References 25 publications

Perioperative Pharmacological Management of Pulmonary Hypertensive Crisis during Congenital Heart Surgery

Perioperative Pharmacological Management of Pulmonary Hypertensive Crisis during Congenital Heart Surgery

Antenatal Hypoxia and Pulmonary Vascular Function and Remodeling

Prenatal Programming of Pulmonary Hypertension Induced by Chronic Hypoxia or Ductal Ligation in Sheep

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