Inhaled nitric oxide therapy after Fontan-type operations.
OBJECTIVE
Inhaled nitric oxide (NO) therapy is a newly developed strategy designed to reduce pulmonary vascular resistance after the Fontan-type operation. We reviewed our experience to evaluate its efficacy and true indications.


METHODS
We retrospectively examined 47 children who received inhaled NO therapy after the Fontan-type operation between August 1996 and December 2002. The maximal dose of NO ranged from 5 to 30 ppm (median 10 ppm), and the duration of inhaled NO therapy ranged from 5 h to 52 days (median 2 days).


RESULTS
Inhaled NO significantly decreased the central venous pressure (CVP), from 16.2 +/- 2.2 to 14.6 +/- 2.2 mmHg (P < 0.0001), and the transpulmonary pressure gradient between the CVP and left atrial pressure, from 9.9 +/- 2.9 to 8.4 +/- 2.7 mmHg (P < 0.0001). It also increased the systolic systemic arterial pressure from 71.9 +/- 15.2 to 76.8 +/- 14.5 mmHg (P < 0.05). In 26 patients with additional fenestration, inhaled NO led to a significant improvement in SaO(2) from 90.1% +/- 9.6% to 93.3% +/- 7.9% (P < 0.01). However, patients with a CVP <15 mmHg or a transpulmonary pressure gradient <8 mmHg, or both, after the Fontan-type operation, showed no significant changes in hemodynamics during inhaled NO therapy.


CONCLUSIONS
We propose that a CVP >/=15 mmHg or a transpulmonary pressure gradient >/=8 mmHg, or both, after Fontan-type operations are appropriate indications for inhaled NO therapy.
Yoshimura
Naoki
N
Department of Cardiothoracic Surgery, Kobe Children's Hospital, 1-1-1 Takakura-dai, Suma-ku, Kobe 654-0081, Japan.
Yamaguchi
Masahiro
M
Oka
Shigeteru
S
Yoshida
Masahiro
M
Murakami
Hirohisa
H
Kagawa
Tetsuro
T
Suzuki
Takeshi
T
D000280:Administration, Inhalation; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000517:prevention & control*; D007223:Infant; D008297:Male; D009569:Nitric Oxide / Q000627:therapeutic use*; D010101:Oxygen Consumption / Q000502:physiology*; D011182:Postoperative Care / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
D009569:Nitric Oxide