Nitric Oxide and Milrinone: Combined Effect on Pulmonary Circulation After Fontan-Type Procedure: A Prospective, Randomized Study

The role of milrinone in children with cardiovascular compromise: review of the literature

“…In another study [8], 46 patients with high pulmonary vascular resistance (TPG > 10 mmHg or central venous pressure >15 mmHg) and impaired oxygenation after Fontan operation were prospectively randomized into three groups: group Mil (n ¼ 15, milrinone at 0.5 mg/kg À1 /min), group iNO (n ¼ 15, iNO at < 20 ppm), and group iNO þ Mil (n ¼ 16, iNO þ Mil).…”

“…Cai et al [8] demonstrated in their RCT that inhalation of iNO in combination with milrinone led to the most significant reduction of pulmonary vascular resistance, while the use of iNO and milrinone as single therapeutic agents was associated with a less pronounced reduction of pulmonary vascular resistance. The same effects and pattern was noted for improvement of arterial blood oxygenation.…”

Pulmonary Arterial Hypertension Associated with Congenital Heart Disease

“…Given the likely relationship of these manifestations of Fontan failure with increases in PVR, this presents an evolving role for targeted PAH therapies in an exponentially growing population of patients with complex CHD. In the immediate postoperative period, studies have demonstrated hemodynamic benefits derived from inhaled nitric oxide alone, or in combination with milrinone [73][74][75]. Although prostacyclins are rarely used in the perioperative period, epoprostenol has been shown to prevent the rebound effects of nitric oxide cessation [76].…”

Advances in the Management of Pediatric Pulmonary Hypertension

“…105 Likewise, investigators have examined the utility of INO in the particular situations of bidirectional cavopulmonary connections and after Fontan procedure. [106][107][108] In those patients, INO decreased central venous pressure and transpulmonary gradient, and increased oxygen saturation. In addition, the pulmonary vascular response to INO has been studied as a part of the assessment for operability in patients with PH associated with congenital heart disease.…”