Nitric oxide-associated pulmonary edema in children with pulmonary venous hypertension.
Nitric oxide (NO)-associated pulmonary edema is rarely reported in children; in adults, it is often associated with left-sided heart failure. We report a case series of children with NO-associated pulmonary edema, which was defined as new multilobar alveolar infiltrates and worsening hypoxemia within 24 h of initiation or escalation of NO and radiologic or clinical improvement after NO discontinuation. We identified six patients (0.4-4 years old) with ten episodes of NO-associated pulmonary edema. Diagnoses included atrioventricular canal defect with mitral valve disease (n = 2), pulmonary atresia and major aorta-pulmonary collateral arteries (n = 2), total anomalous pulmonary venous return (n = 1), and pulmonary veno-occlusive disease (n = 1). All patients had evidence of pulmonary venous hypertension, and two had mitral valve disease resulting in clinical evidence of left-sided heart failure. Pulmonary edema improved or resolved within 24 h of discontinuing NO. At cardiac catheterization, mean left atrial pressure was <15 mmHg in three of three patients (none with mitral valve disease), whereas pulmonary artery occlusion pressure was >15 mmHg in two of five patients. In conclusion, we describe six young children with NO-associated pulmonary edema and pulmonary venous hypertension. Only two of these children had left-sided heart failure: Left atrial pressure as well as pulmonary artery occlusion pressure may not be helpful in identifying children at risk for NO-associated pulmonary edema.
College of Physicians and Surgeons, Children's Hospital of New York-Presbyterian, Columbia University, 3959 Broadway, CHN 10-24, New York, NY 10032, USA. jsb106@columbia.edu
J Scott
JS
Baird
Vinod
V
Havalad
Linda
L
Aponte-Patel
Thyyar M
TM
Ravindranath
Tessie W
TW
October
Thomas J
TJ
Starc
Arthur J
AJ
Smerling
D006328:Cardiac Catheterization; D002675:Child, Preschool; D004062:DiGeorge Syndrome / Q000628:therapy; D004314:Down Syndrome / Q000628:therapy; D045462:Endothelium-Dependent Relaxing Factors / Q000009:adverse effects*; D005260:Female; D006330:Heart Defects, Congenital / Q000188:drug therapy*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D007223:Infant; D008297:Male; D009569:Nitric Oxide / Q000009:adverse effects*; D011654:Pulmonary Edema / Q000139:chemically induced*; D011667:Pulmonary Veins / Q000002:abnormalities; D011668:Pulmonary Veno-Occlusive Disease / Q000628:therapy
D045462:Endothelium-Dependent Relaxing Factors; D009569:Nitric Oxide