Nitric oxide in neonatal transposition of the great arteries.
Three newborn infants with transposition of the great arteries (TGA) and intact ventricular septum (IVS) developed postnatal persistent pulmonary hypertension of the newborn (PPHN) and were successfully treated with inhaled nitric oxide (iNO). Intervention with balloon atrial septostomy (BAS) was performed in two of the infants before the iNO treatment, but they continued to be severely hypoxic with metabolic acidosis. However, the iNO immediately improved oxygenation and the clinical condition. The third neonate had a moderately large atrial communication and echocardiographic signs of PPHN. He received iNO before BAS with dramatic clinical improvement, which therefore postponed BAS.


CONCLUSIONS
Early diagnosis of PPHN and treatment with iNO may improve final outcome in neonates with TGA and IVS. In the presence of moderately large atrial communication and PPHN, treatment with iNO might be considered before BAS.
El-Segaier
Milad
M
Division of Paediatric Cardiology, Department of Paediatrics, Children's Hospital, Lund University Hospital, SE-221 85 Lund, Sweden. milad.el-segaier@skane.se
Hellström-Westas
Lena
L
Wettrell
Göran
G
D002404:Catheterization; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D010547:Persistent Fetal Circulation Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D014188:Transposition of Great Vessels / Q000150:complications*; D017211:Treatment Failure
D009569:Nitric Oxide; D010100:Oxygen