title: Nitric oxide inhalation modulates endothelin-1 plasma concentration gradients following left ventricular assist device implantation.
abstract: Inhaled nitric oxide (iNO) therapy is an effective treatment of pulmonary hypertension following left ventricular assist device (LVAD) implantation. As iNO may also modulate circulating endothelin-1 (ET-1) and big endothelin following LVAD implantation, we investigated the effects of iNO on ET-1 and big endothelin plasma concentration gradients. In order to assist weaning from cardiopulmonary bypass, iNO was administered to 15 consecutive patients with secondary pulmonary hypertension following implantation of a LVAD. Central venous, pulmonary arterial and arterial ET-1 and big endothelin plasma levels were measured preoperatively, on cardiopulmonary bypass prior to iNO administration, 12, 24 and 48 hours postoperatively, and 72 hours after weaning from iNO. The ET-1 gradients between central venous and pulmonary arterial plasma levels decreased significantly with time, and there was a trend for lower arterial-pulmonary arterial plasma concentration gradients. Big endothelin plasma concentration gradients were not altered significantly. The decrease in ET-1 plasma concentration gradients during and after iNO administration may reflect a restoration of the physiologic balance between the different vascular beds. This provides further evidence that intermittent iNO therapy may modulate ET-1 after LVAD implantation.
authors.affiliation: Deutsches Herzzentrum Berlin, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Wagner
authors.forename: Semih
authors.initials: S
authors.lastname: Buz
authors.forename: Hans-H
authors.initials: HH
authors.lastname: Neumeyer
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Berthold
authors.initials: B
authors.lastname: Hocher
mesh_terms: D000280:Administration, Inhalation; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002303:Cardiac Output, Low / Q000150:complications / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D002315:Cardiopulmonary Bypass; D002496:Central Venous Pressure / Q000187:drug effects; D015536:Down-Regulation; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology
chemical_list: D000959:Antihypertensive Agents; D019332:Endothelin-1; D009569:Nitric Oxide