Nitric oxide, oxygen, and prostacyclin in children with pulmonary hypertension

Turanlahti, Maila; Laitinen, Pirjo; Sarna, Seppo; Pesonen, Erkki

doi:10.1136/hrt.79.2.169

Cited by 31 publications

(14 citation statements)

References 25 publications

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“…Oxygen, nitric oxide inhalation, and prostanoid (intravenous and inhalation) are the vasodilating agents used to test pulmonary vascular reactivity in these patients. [47] Nitric oxide inhalation lowers mean pulmonary artery pressure and pulmonary vascular resistance irrespective of etiology of PAH. [48] Nitric oxide in a dose range of 5 to 40 parts per million (ppm) has been used in addition to 100% oxygen in preoperative evaluation of pulmonary vascular resistance in children with CHD.…”

Section: Cardiac Catheterizationmentioning

confidence: 99%

Advances in diagnosis and treatment of pulmonary arterial hypertension in neonates and children with congenital heart disease

Suesaowalak¹,

Cleary

Chang

2010

World J Pediatr

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Among the different forms of congenital heart diseases, an early correction generally prevents subsequent development of pulmonary arterial hypertension. Emerging therapies for treatment of patients with idiopathic pulmonary arterial hypertension also improve quality of life and survival in neonates and children with congenital heart disease associated with pulmonary arterial hypertension. Heart and lung transplantation or lung transplantation in combination with repair of the underlying cardiac defect is a therapeutic option in a minority of patients. Partial repair options are also beneficial in some selected cases. Randomized controlled trials are needed to evaluate the safety and efficacy of these therapies including survival and long-term outcome.

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Section: Cardiac Catheterizationmentioning

confidence: 99%

Advances in diagnosis and treatment of pulmonary arterial hypertension in neonates and children with congenital heart disease

Suesaowalak¹,

Cleary

Chang

2010

World J Pediatr

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“…Several recent advances such as the use of pharmaceutical agents to decrease pulmonary artery (PA) pressures and pulmonary vascular resistance (PVR) have facilitated the treatment of such patients. [1][2][3][4][5] Although assessment of the hemodynamic status of the pulmonary vasculature is a major component in treatment evaluation, the question of how best to do this is still unanswered. 6,7 Current methods evaluate hypertension and vascular reactivity through measurement of PVR, which is the ratio of mean pressure drop across the pulmonary vasculature to mean pulmonary flow and which is based on the assumption of steady hemodynamics.…”

mentioning

confidence: 99%

Extraction of Pulmonary Vascular Compliance, Pulmonary Vascular Resistance, and Right Ventricular Work From Single-Pressure and Doppler Flow Measurements in Children With Pulmonary Hypertension: a New Method for Evaluating Reactivity

et al. 2004

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Background-Current evaluation of pulmonary hypertension (PH) in children involves measurement of pulmonary vascular resistance (PVR); however, PVR neglects important pulsatile components. Pulmonary artery (PA) input impedance and ventricular power (VP) include mean and pulsatile effects and have shown promise as alternative measures of vascular function. Here we report the utility of pulsed-wave (PW) Doppler-measured instantaneous flow and pressure measurements for estimation of input impedance and VP and use this method to develop a novel parameter: reactivity in compliance. Methods and Results-An in vitro model of the general pulmonary vasculature was used to obtain impedance and VP, measured by PW Doppler and a reference flow meter. The method was then tested in a preliminary clinical study in subjects with normal PA hemodynamics (nϭ4) and patients with PH undergoing reactivity evaluation (8 patients; 23 data points). In vitro results showed good agreement between the impedance spectra computed from both flowmeasurement methods. Excellent correlation was seen in vitro between actual resistance and the zero-frequency (Z o ) impedance value (r 2 ϭ0.984). Excellent agreement was also found between Z o and PVR in the clinical measurements (yϭ1.075xϩ0.73; rϭ0.993). Furthermore, total VP and VP/cardiac output increased significantly with hypertension (128.73 to 365.91 mW and 2.42 to 6.69 mW · mL Ϫ1 · s Ϫ1 , respectively). The first-harmonic value of impedance (Z 1 ) was used as a measure of compliance reactivity; older patients exhibited markedly less compliance reactivity than did younger patients. Conclusions-Input impedance and VP calculated from Doppler measurements and a single-catheter pressure measurement provide comprehensive characterization of PH and reactivity.

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“…In our patient, we did not see significant reduction in pulmonary artery pressure on echocardiography until iNO and iPGI 2 were co‐administered. We also cannot exclude the role of sildenafil and its synergism with PGI 2 18,19 because sildenafil was baseline therapy. An additive effect provided by PGI 2 to either agent should not be surprising.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Refractory Pulmonary Arterial Hypertension with Inhaled Epoprostenol in an Infant with Congenital Heart Disease

Kovach

Ibsen

Womack³

et al. 2007

Congenital Heart Disease

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Epoprostenol is a potent arterial vasodilator, and its administration by inhalation localizes its effects to the pulmonary circulation. In this case report, we describe a 3-month-old male patient with significant refractory pulmonary hypertension after pulmonary artery banding and placement of a Blalock-Taussig shunt. This patient continued to have significant hypoxic episodes despite maximal therapy with sedation, alkalinization, sildenafil, and inhaled nitric oxide. After the addition of inhaled epoprostenol, improvements in both clinical response and echocardiography-based hemodynamics were observed. The case supports a synergistic role among the agents in the treatment of pulmonary arterial hypertension from congenital heart disease.

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Nitric oxide, oxygen, and prostacyclin in children with pulmonary hypertension

Cited by 31 publications

References 25 publications

Advances in diagnosis and treatment of pulmonary arterial hypertension in neonates and children with congenital heart disease

Advances in diagnosis and treatment of pulmonary arterial hypertension in neonates and children with congenital heart disease

Extraction of Pulmonary Vascular Compliance, Pulmonary Vascular Resistance, and Right Ventricular Work From Single-Pressure and Doppler Flow Measurements in Children With Pulmonary Hypertension: a New Method for Evaluating Reactivity

Treatment of Refractory Pulmonary Arterial Hypertension with Inhaled Epoprostenol in an Infant with Congenital Heart Disease

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