Use of inhaled nitric oxide to reduce pulmonary hypertension after heart transplantation

Life-threatening effects of discontinuing inhaled nitric oxide in severe respiratory failure.

“…A beneficial effect elicited by the inhalation of nitric oxide (NO) has been reported in both adults and children with respiratory failure, including patients with the adult respiratory distress syndrome (ARDS) (1)(2)(3)(4)(5), primary pulmonary hypertension (6), or cor pulmonale secondary to congenital heart disease (7), and after cardiac surgery (1) or cardiac transplantation (1,8). These studies have emphasized a decrease in pulmonary arterial pressure (with no decrease in cardiac output) and improvement in oxygenation.…”

Inhaled nitric oxide in patients with normal and increased pulmonary vascular resistance after cardiac surgery

“…Addition of nitric oxide to inhaled gases has been shown to reduce selectively pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (MPAP) in patients with ARDS [13], persistent fetal circulation [14] and secondary pulmonary hypertension [15,16], and to counteract hypoxic pulmonary vasoconstriction in volunteers breathing hypoxic gas mixtures [17]. Several groups of cardiac surgical patients may benefit from therapeutic use of nitric oxide for selective manipulation of the pulmonary circulation; these include heart transplant recipients [18], patients with pulmonary hypertension [16] and patients with end-stage cardiac failure awaiting transplantation. Pulmonary hypertension, denned as MPAP exceeding 22 mm Hg or systolic PAP greater than 30 mm Hg [19], is a common feature in patients with chronic mitral stenosis.…”