[Inhalation nitric oxide during heart transplantation].
Effect and dose dependence of iNO as a selective vasodilator of the lesser circulation on the central hemodynamics was studied in 24 patients subjected to transplantation of the heart. iNO in concentrations of up to 20 ppm ensured objective evaluation of the reversibility of the pretransplantation pulmonary hypertension. Before transplantation iNO in a concentration higher than 20 ppm led to deterioration of left-ventricular function, associated with a 19% increase in pulmonary artery wedge pressure and a 13% decrease of cardiac index in patients with a less than 15 mm Hg transpulmonary gradient and pulmonary vascular resistance higher than 320 din.sec.cm-5. During left-ventricular bypass, iNO dose-dependently decreased the mean pulmonary artery pressure, transpulmonary gradient, pulmonary vascular resistance, pulmonary to peripheral vascular resistance ratio and the right-ventricular stroke index and increased the left-ventricular assist bypass by 17% in patients waiting for orthotopic heart transplantation. Early after transplantation, iNO in a concentration of 20 ppm notably decreased the pulmonary vascular resistance and stabilized the function of transplanted heart, increasing the cardiac index by 19% and blood pressure by 16%. During diagnostic and therapeutic manipulations at 10-20 ppm iNO the level of NO2 was no higher than 2.5 ppm, or 3 ppm at 30-40 ppm.
Kozlov
I A
IA
Poptsov
V N
VN
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D002648:Child; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D016027:Heart Transplantation / Q000379:methods* / Q000502:physiology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D009569:Nitric Oxide / Q000008:administration & dosage*; D014665:Vasodilator Agents / Q000008:administration & dosage*; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery
D014665:Vasodilator Agents; D009569:Nitric Oxide