title: Usefulness of nitric oxide treatment for pulmonary hypertensive infants during cardiac anesthesia.
abstract: BACKGROUND
  The beneficial effect of inhaled nitric oxide (NO) on pulmonary hypertension is well known. However, the indications for NO inhalation therapy for pulmonary hypertension associated with congenital heart lesions are still unclear. The aim of the current study was to seek a measure that would predict the effectiveness of inhaled NO in infants undergoing cardiac surgery.
  
  
  METHODS
  Forty-six infants with pulmonary hypertension were studied. Pulmonary vascular resistance (PVR) measured at the time of cardiac catheterization was used as an indicator and compared with pulmonary arterial pressure/systemic blood pressure ratio (Pp/Ps) at the time of weaning from cardiopulmonary bypass. The effect of 40 ppm of inhaled NO for 15 min was evaluated in patients whose Pp exceeded systemic values.
  
  
  RESULTS
  Preoperative PVR correlated positively with Pp/Ps at the time of weaning from cardiopulmonary bypass (r2 = 0.86; P < 0.05; n = 46). A Pp/Ps greater than or equal to 1 was not observed in any cases in which the preoperative PVR values were less than 7 Wood units m2; Pp/Ps ratio greater than or equal to 1 occurred in four patients. Each of these had PVR values greater than 7 Wood units m2. Three of these patients who had PVR values in the 7-12 Wood units m2 range were responsive to inhaled NO. The fourth patient, whose PVR value was greater than 15 Wood units m2, was unresponsive. Lung biopsy specimens were obtained in two patients whose preoperative PVR values were greater than 10 Wood units m2.
  
  
  CONCLUSIONS
  Preoperative PVR correlates reasonably well with postbypass Pp/Ps.
authors.affiliation: Department of Anesthesiology, Iwate Medical University Memorial Heart Center, Iwate, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Kadosaki
authors.forename: Takae
authors.initials: T
authors.lastname: Kawamura
authors.forename: Kotaro
authors.initials: K
authors.lastname: Oyama
authors.forename: Noriko
authors.initials: N
authors.lastname: Nara
authors.forename: Jicheng
authors.initials: J
authors.lastname: Wei
authors.forename: Naohisa
authors.initials: N
authors.lastname: Mori
mesh_terms: D000280:Administration, Inhalation; D001794:Blood Pressure; D002315:Cardiopulmonary Bypass; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D007223:Infant; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D011651:Pulmonary Artery / Q000473:pathology / Q000503:physiopathology; D014655:Vascular Resistance
chemical_list: D009569:Nitric Oxide