Efficacy of nitroglycerin inhalation in reducing pulmonary arterial hypertension in children with congenital heart disease

Abstract

Inhaled nitroglycerin significantly decreases systolic, diastolic and mean pulmonary artery pressure as well as PVRI without affecting systemic haemodynamics, and thus can be used as a therapeutic modality for acute reduction of PAH in children with congenital heart disease.

Advances in diagnosis and treatment of pulmonary arterial hypertension in neonates and children with congenital heart disease

“…Nitroglycerin Nitroglycerin inhalation as a nitric oxide donor decreases systolic, diastolic, and mean pulmonary artery pressure and pulmonary vascular resistance index without affecting systemic hemodynamics during cardiac catheterization and may be an alternative treatment for acute reduction of PAH in children with CHD. [126,127] Combination therapy Because of various mechanisms involving in pathogenesis and pathophysiology of PAH, combination Diagnosis and treatment of PAH in neonates and children with CHD…”

Acute hemodynamic effects of inhaled nitroglycerine, intravenous nitroglycerine, and their combination with intravenous dobutamine in patients with secondary pulmonary hypertension

“…LAP = left atrial pressure, MVR = mitral valve replacement, DVR = double valve replacement, NSR = normal sinus rhythm, AF = atrial fibrillation, CVR = controlled ventricular rate, FVR = fast ventricular rate, abs = absent, prs = present, AP = atrial pacing, AVS = atrioventricular sequential pacing in systolic, diastolic, and mean PAP as well as PVRI, without it affecting the systemic hemodynamics and they postulated that it could be used as a therapeutic modality for acute reduction of PAH in children with congenital heart disease. [3] In a study by Gong et al, in dogs with experimentally induced PAH, inhalation of nebulized NTG decreases mPAP, dPAP, and sPAP without affecting SBP, DBP, MAP, SVR or CO. [12] In our study the median PVR / SVR ratio decreased with inhaled NTG (24%), (p < 0.001) indicating selectivity to the pulmonary vasculature. The selective pulmonary vasodilatation did not lead to inhibition of HPV, hence the higher SvO 2 with iNTG.…”

“…[1,2] Also, it is effective in children with congenital heart disease with PAH. [3] iNTG also exerts a favorable effect on oxygenation as it does not inhibit hypoxic pulmonary vasoconstriction (HPV), thereby preventing any increase in intrapulmonary shunt fraction. [1,4] In cardiac surgical patients the combination of IV NTG and dobutamine in a low dose, 5 -10 µg/kg/min, is routinely used for decreasing PAP and increasing cardiac output (CO).…”

Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Perioperative management in patients with pulmonary hypertension

“…Data are promising for the use of other therapies such as inhaled milrinone (less systemic effects than the IV form),[122123124] inhaled nitroglycerin (more selective pulmonary vasodilatory effects),[125126] IV iloprost,[127] inhaled sildenafil,[128] and IV levosimendan (myocardial calcium sensitizer and pulmonary vasodilator). [73129130] Further studies are needed before specific recommendations regarding these therapies can be provided.…”