title: Inhaled nitric oxide in patients with critical pulmonary perfusion after Fontan-type procedures and bidirectional Glenn anastomosis.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effects of inhaled nitric oxide in patients with critical pulmonary perfusion after Fontan-type procedures and bidirectional Glenn anastomosis.
  
  
  METHODS
  Inhaled nitric oxide (mean 4.1 +/- 0.7 ppm, 1.5 to 10 ppm) was administered in 13 patients (mean age 5.6 +/- 1.6 years, 1.5 to 17 years) with critical pulmonary perfusion (central venous pressure > 20 mm Hg or transpulmonary pressure gradient > 10 mm Hg) in the early postoperative period after total cavopulmonary connection (n = 9) or after bidirectional Glenn anastomosis (n = 4).
  
  
  RESULTS
  In patients after total cavopulmonary connection inhaled nitric oxide therapy decreased central venous pressure by 15.3% +/- 1.4% (p = 0.0001) and transpulmonary pressure gradient by 42% +/- 8% (p = 0.0008) and increased mean systemic arterial and left atrial pressures by 12% +/- 3.6% (p = 0.011) and 28% +/- 8% (p = 0.007), respectively. Arterial and venous oxygen saturations improved by 8.2% +/- 1% (p = 0.005) and 14% +/- 4.3% (p = 0.03), respectively. In patients after bidirectional Glenn anastomosis inhaled nitric oxide therapy resulted in a decrease of central venous pressure by 22% +/- 1% and of the transpulmonary pressure gradient by 55% +/- 6% and improved arterial and venous oxygen saturations by 37% +/- 29% and 11% +/- 3%, respectively. Mean systemic arterial and left atrial pressures remained nearly unchanged. No toxic side effect was observed in any patient.
  
  
  CONCLUSIONS
  Inhaled nitric oxide may play an important role in the management of transient critical pulmonary perfusion caused by reactive elevated pulmonary vascular resistance in the early postoperative period after Fontan-type operations and bidirectional Glenn anastomosis.
authors.affiliation: Department of Pediatric Cardiology, University of Graz, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Gamillscheg
authors.forename: G
authors.initials: G
authors.lastname: Zobel
authors.forename: B
authors.initials: B
authors.lastname: Urlesberger
authors.forename: J
authors.initials: J
authors.lastname: Berger
authors.forename: D
authors.initials: D
authors.lastname: Dacar
authors.forename: J I
authors.initials: JI
authors.lastname: Stein
authors.forename: B
authors.initials: B
authors.lastname: Rigler
authors.forename: H
authors.initials: H
authors.lastname: Metzler
authors.forename: A
authors.initials: A
authors.lastname: Beitzke
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D007223:Infant; D008168:Lung / Q000098:blood supply* / Q000502:physiology; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy*; D014655:Vascular Resistance
chemical_list: D009569:Nitric Oxide