Effect of inhaled nitric oxide on raised pulmonary vascular resistance in children with congenital heart disease.

Winberg, P.; Lundell, Bo; Gustafsson, L. E.

doi:10.1136/hrt.71.3.282

Cited by 54 publications

(20 citation statements)

References 25 publications

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“…The system for administrating NO by inhalation reported by Winberg et al [12] was used in this study. We placed a transparent plexiglas hood over the head of the infant and sealed it around the neck with a thin plastic wrap.…”

Section: Methodsmentioning

confidence: 99%

“…In general, minimally effective doses of inhaled NO are recommended to prevent lung injury [14]. Data of cardiac catheterizations with inhaled NO have been reported [1,6,11,12]. However, the effect of low-dose NO [<40 parts per million (ppm)] had not been studied.…”

mentioning

confidence: 97%

“…The inhalation of nitric oxide (NO), a selective pulmonary vasodilator, is used to evaluate and treat patients with pulmonary hypertension (PH) secondary to congenital heart disease (CHD) [1,6,11,12]. In general, minimally effective doses of inhaled NO are recommended to prevent lung injury [14].…”

mentioning

confidence: 99%

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Inhalation of Low-Dose Nitric Oxide to Evaluate Pulmonary Vascular Reactivity in Children with Congenital Heart Disease

Yasuda

Tauchi²,

Baba³

et al. 1999

Pediatr Cardiol

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The objective of this study was to investigate the efficacy of low-dose nitric oxide (NO). The study used fifteen consecutive Japanese preoperative patients (7 males and 8 females) with congenital heart disease and pulmonary hyptertension (mean pulmonary arterial pressure >30 mmHg), 6 of these patients had Down's syndrome. Hemodynamic measurements were taken in room air, 100% oxygen, 5 and 40 parts per million NO (NO5 and NO40) by inhalation. The differences between two observations within the same group were determined by the two-tailed paired t-test. A pulmonary vascular resistance (Rp) regression curve was constructed by using linear regression analysis. The percentage change in pulmonary arterial pressure per systemic arterial pressure (Pp/Ps) with NO40 (Pp/Ps-40) exceeded that of Pp/Ps-5 (p < 0.0001). The percentage change for the Rp with NO40 (Rp-40) was larger than that for the Rp-5 (p = 0.0003). The percentage change of Pp/Ps-5 and that with oxygen were similar (p = 0.266). The relationship between Rp-5 and Rp-40 was linear. In conclusion, the effects of NO5 were equivalent to 100% oxygen but less than NO40. NO5 should initially be used to test pulmonary reactivity. If there is no response, patients should still be given NO40.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 97%

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Inhalation of Low-Dose Nitric Oxide to Evaluate Pulmonary Vascular Reactivity in Children with Congenital Heart Disease

Yasuda

Tauchi²,

Baba³

et al. 1999

Pediatr Cardiol

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“…In addition, the response to iNO is influenced by the maturity of the patient [9,18,19] and the degree of pulmonary injury [8]. NO only affects constricted pulmonary vessels and is unlikely to improve patients with parenchymal disease [20]. An increase in oxygenation is more likely in infants with no or slight interstitial or alveolar infiltrates and less pronounced in patients with gross pathology [8].…”

Section: Discussionmentioning

confidence: 99%

Plasma Arginine Levels and the Response to Inhaled Nitric Oxide in Neonates

Kavvadia

Greenough²,

Lilley³

et al. 1999

Neonatology

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Inhaled nitric oxide (iNO) can be an effective vasodilator in pulmonary hypertension of the newborn (PHN). The aim of this study was to determine whether differences in arginine levels, from which endogenous NO is produced, explain the variability in response to NO and whether the arginine levels were lower in term and preterm infants with PHN than in infants without PHN (controls). We prospectively studied 30 infants (17 born preterm) with clinically diagnosed PHN and treated with iNO and 22 controls (14 born preterm). Three NO levels (10, 20, 40 ppm) were administered to the PHN infants to identify that associated with maximum oxygenation. Twenty-seven infants with PHN improved following iNO and had lower arginine levels than those infants who did not respond to iNO (p < 0.05). No significant relationship, however, was noted between the arginine levels and either the magnitude of change in the oxygenation index in response to iNO or the NO level associated with maximum oxygenation. The median plasma arginine level prior to iNO of the PHN infants was 12.5 (range 2–53) μmol/l, but not significantly lower than that of the controls (median 24, range 3–82 μmol/l). We conclude that differences in plasma arginine levels are unlikely to explain the variation in response to iNO and that, although arginine levels tended to be lower in infants with PHN, this is not a consistent finding in either the term or preterm infants.

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“…After inhalation, the vasodilatory effect of iNO is restricted to the lung, because systemically absorbed, NO is rapidly (within seconds) inactivated by binding to hemoglobin; iNO does not affect basal pulmonary vascular tone [25][26][27] but may cause selective pulmonary vasodilation and improve gas exchange in animals or humans with pulmonary hypertension and/or hypoxemia due to VA/Q mismatch [for review see [28][29][30][31][32]. Species differences exist with respect to the vasodilatory potency of iNO [7,[33][34][35].…”

Section: Inhalation Of Exogenous Nomentioning

confidence: 99%

Searching the Ideal Inhaled Vasodilator: From Nitric Oxide to Prostacyclin

et al. 2002

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Today, the technique to directly administer vasodilators via the airway to treat pulmonary hypertension and to improve pulmonary gas exchange is widely accepted among clinicians. The flood of scientific work focussing on this new therapeutic concept had been initiated by a fundamental new observation by Pepke-Zaba [1]and Frostell in 1991 [2]: Both scientists reported, that inhalation of exogenous nitric oxide (NO) gas selectively dilates pulmonary vessels without a concomittant systemic vasodilation. No more than another decade ago NO was identified as an important endogenous vasodilator [3]while having merely been regarded an environmental pollutant before that time. Although inhaled NO proved to be efficacious, alternatives were sought-after due to NO’s potential side-effects. In search for the ideal inhaled vasodilator another group of endogenous mediators – the prostanoids – came into the focus of interest. The evidence for safety and efficacy of inhaled prostanoids is – among a lot of other valuable work – based on a series of experimental and clinical investigations that have been performed or designed at the Institute for Surgical Research under the guidance and mentorship of Prof. Dr. med. Dr. h.c. mult. K. Messmer [4-19]. In the following, the current and newly emerging clinical applications of inhaled prostanoids and the experimental data which they are based on, will be reviewed.

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Effect of inhaled nitric oxide on raised pulmonary vascular resistance in children with congenital heart disease.

Cited by 54 publications

References 25 publications

Inhalation of Low-Dose Nitric Oxide to Evaluate Pulmonary Vascular Reactivity in Children with Congenital Heart Disease

Inhalation of Low-Dose Nitric Oxide to Evaluate Pulmonary Vascular Reactivity in Children with Congenital Heart Disease

Plasma Arginine Levels and the Response to Inhaled Nitric Oxide in Neonates

Searching the Ideal Inhaled Vasodilator: From Nitric Oxide to Prostacyclin

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