Nitric oxide and prostacyclin lower suprasystemic pulmonary hypertension after cardiopulmonary bypass.
In a 3-week-old male newborn persistent suprasystemic pulmonary hypertension developed after surgical valvulotomy for a critical aortic valve stenosis. Because of a residual transvalvular pressure gradient of 35 mmHg and postoperative left as well as right ventricular dysfunction, treatment with inhaled nitric oxide (NO) and intravenously infused prostacyclin (PGI2) was attempted. Low-dose inhaled NO and low dose PGI2 corrected severe pulmonary hypertension and led to an increase in cardiac output. Treatment with NO but not PGI2 was accompanied by a rise in PaO2 and systemic blood pressure. Interruption of NO administration led to a rapid increase in pulmonary arterial pressure to suprasystemic levels. With continued i.v. PGI2 and decreasing concentrations of NO, severe pulmonary hypertension resolved after a few days suggesting that a transient endothelial dysfunction was partially responsible for pulmonary vasoconstriction. NO inhalation appears to be an effective new tool in the treatment of severe pulmonary hypertension following cardiac surgery.
Schranz
D
D
Department of Paediatrics, University of Mainz, Germany.
Huth
R
R
Wippermann
C F
CF
Ritzerfeld
S
S
Schmitt
F X
FX
Oelert
H
H
D000280:Administration, Inhalation; D001024:Aortic Valve Stenosis / Q000151:congenital / Q000601:surgery; D001794:Blood Pressure / Q000187:drug effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D011464:Epoprostenol / Q000008:administration & dosage*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage*; D011183:Postoperative Complications
D009569:Nitric Oxide; D011464:Epoprostenol