Inhaled nitric oxide in the management of congenital heart disease

Current Opinion in Cardiology

Volumn 11, Issue 1, 1996, Pages 75-80

  Kulik, Thomas J ^a  

^a UNIVERSITY OF MICHIGAN   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

METHEMOGLOBIN; NITRIC OXIDE;

CONGENITAL HEART DISEASE; DRUG SAFETY; HEART TRANSPLANTATION; HUMAN; INHALATIONAL DRUG ADMINISTRATION; LUNG VASCULAR RESISTANCE; POSTOPERATIVE CARE; POSTOPERATIVE COMPLICATION; PREOPERATIVE CARE; PRIORITY JOURNAL; PULMONARY HYPERTENSION; REVIEW; VASODILATATION;

HEART DEFECTS, CONGENITAL; HEMODYNAMIC PROCESSES; HUMANS; NITRIC OXIDE; OXYGEN CONSUMPTION; TREATMENT OUTCOME; VASCULAR RESISTANCE; VASODILATOR AGENTS; VENTRICULAR FUNCTION;

EID: 0029970551     PISSN: 02684705     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001573-199601000-00012     Document Type: Review

References (29)

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14. 2 formation in a respiratory circuit used to deliver inhaled NO and where the inspired gas is appropriately sampled for monitoring. Useful discussion.
15. Edwards AD: The pharmacology of nitric oxide. Arch Dis Child 1995, 72:F127-F130. A succinct yet wide-ranging review of the pharmacology of inhaled NO.
16. 2 and blood hemoglobin should be expected if inhaled NO is properly delivered and monitored. In addition, the multiple technical issues relevant to safely delivering inhaled NO are discussed in considerable detail.
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19. Wessel DL, Adatia I, Giglia TM, Thompson JE, Kulik TJ: Use of inhaled nitric oxide and acetylcholine in the evaluation of pulmonary hypertension and endothelial function after cardiopulmonary bypass. Circulation 1993, 88:2128-2138.
20. Winberg P, Lundell BPW, Gustafsson LE: Effect of inhaled nitric oxide on raised pulmonary vascular resistance in children with congenital heart disease. Br Heart J 1994, 71:282-286. A nicely done study of the effects of inhaled NO in infants and children with unrepaired congenital heart lesions.
21. Day RW, Lynch JM, Shaddy RE, Orsmond GS: Pulmonary vasodilatory effects of 12 and 60 parts per million inhaled nitric oxide in children with ventricular septal defect. Am J Cardiol 1995, 75:195-198. This study is consistent with others showing inhaled NO to be a selective pulmonary vasodilator, and it suggests that relatively low-dose inhaled NO is as effective as higher concentrations, at least in patients with (presumably) little pulmonary pathology.
22. Miller OI, Celermajer DS, Deanfield JE, Macrae DJ: Very-low-dose inhaled nitric oxide: a selective pulmonary vasodilator after operations for congenital heart disease. J Thorac Cardiovasc Surg 1994, 108:487-494. The first report to show very-low-dose inhaled NO (2 ppm) vasodilates the lungs after cardiac surgery and to show that increasing the dose to 20 ppm did not augment this vasodilation. These findings are of potential importance, given the relevant toxicologic considerations, but it is as yet unclear how widely applicable they are.
23. Journois D, Pouard P, Mauriat P, Malhere T, Vouhe P, Safran D: Inhaled nitric oxide as a therapy for pulmonary hypertension after operations for congenital heart defects. J Thorac Cardiovasc Surg 1994, 107:1129-1135. The largest study to date of inhaled NO given to treat pulmonary hypertension after repair of congenital cardiac lesions.
24. Adatia I, Lillehei C, Arnold JH, Thompson JE, Palazzo R, Fackler JC, Wessel DL: Inhaled nitric oxide In the treatment of postoperative graft dysfunction after lung transplantation. Ann Thorac Surg 1994, 57:1311-1318. Consistent with reports of patients given inhaled NO after repair of cardiac lesions, this study shows NO to selectively vasodilate the lungs and to decrease intrapulmonary shunting; exactly how useful this finding is is difficult to know.
25. Beghetti M, Habre W, Friedli B, Berner M: Continuous low dose inhaled nitric oxide for treatment of severe pulmonary hypertension after cardiac surgery in paediatric patients. Br Heart J 1995, 73:65-68. Although PVR was not measured, the data presented tend to confirm other reports showing inhaled NO at fairly low dose to be a pulmonary vasodilator in the postoperative cardiac patient.
26. Adatia I, Perry S, Landzberg M, Moore P, Thompson JE, Wessel DL: Inhaled nitric oxide and hemodynamlc evaluation of patients with pulmonary hypertension before transplantation. J Am Coll Cardiol 1995, 25:1656-1664. An appealing study suggesting that inhaled NO may be able to discriminate patients with reversibly increased PVR from those whose increased PVR is "fixed." The paper would have been more interesting had comparison of the effects of NO been made with non-endothelial-dependent conventional vasodilators (eg, nitroprusside or enhanced inspired oxygen), but it makes a strong argument for measuring the effect of NO in these patients.
27. Loh E, Stamler JS, Hare JM, Loscalzo J, Colucci WS: Cardiovascular effects of inhaled nitric oxide in patients with left ventricular dysfunction. Circulation 1994, 90:2780-2785. Along with a contemporary paper by Kieler-Jensen (J Heart Lung Transplant 1994, 13:366-375), this study suggests that selective pulmonary vasodilation, in conjunction with a dysfunctional left ventricle, can cause increased left atrial pressure with no change in PAP and little change in cardiac output. Inclusion of left ventricular peak +dP/dT and dP/dT help bolster the argument that inhaled NO did not diminish left ventricular function.
28. Kieler-Jensen N, Ricksten S-E, Stenqvist O, Bergh C-H, Lindelov B, Wennmalm A, Waagstein F, Lundin S: Inhaled nitric oxide in the evaluation of heart transplantation candidates with elevated pulmonary vascular resistance. J Heart Lung Transplant 1994, 13:366-375. As with Loh et al. (Circulation 1994, 90:2780-2785), the hemodynamic findings presented in this study are unusual and thought-provoking. The hemodynamic effects of inhaled NO, prostacycline, and nitroprusside on pulmonary and systemic hemodynamics are compared and add considerable interest to this paper.
29. Snell GI, Salmonsen RF, Bergin P, Esmore DS, Khan S, Williams TJ: Inhaled nitric oxide used as a bridge to heart-lung transplantation in a patient with end-stage pulmonary hypertension. Am J Respir Crit Care Med 1995, 151:1263-1266.