Inhaled nitric oxide and hemodynamic evaluation of patients with pulmonary hypertension before transplantation

Adatia, Ian; Perry, S G; Landzberg, Michael J.; Moore, Philip; Thompson, John E.; Wessel, David

doi:10.1016/0735-1097(95)00048-9

Cited by 107 publications

(30 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Partial or complete reversibility of elevations of pulmonary vascular resistance and transpulmonary gradient can be observed in patients acutely tested with pulmonary vasodilators such as nitroprusside, prostaglandins, and nitric oxide. 180,[185][186][187][188] Prolonged administration of inotropic agents has also been associated with pulmonary resistance reduction. 185 In these studies, heart transplantation was performed successfully in patients with baseline elevated pulmonary vascular resistance that demonstrated reversibility to a pulmonary vascular resistance index Ͻ6 Woods units/m 2 or transpulmonary gradient Ͻ15 mm Hg.…”

Section: Pulmonary Vascular Resistancementioning

confidence: 99%

Indications for Heart Transplantation in Pediatric Heart Disease

Canter¹,

Shaddy²,

Bernstein³

et al. 2007

Circulation

258

View full text Add to dashboard Cite

Background— Since the initial utilization of heart transplantation as therapy for end-stage pediatric heart disease, improvements have occurred in outcomes with heart transplantation and surgical therapies for congenital heart disease along with the application of medical therapies to pediatric heart failure that have improved outcomes in adults. These events justify a reevaluation of the indications for heart transplantation in congenital heart disease and other causes of pediatric heart failure. Methods and Results— A working group was commissioned to review accumulated experience with pediatric heart transplantation and its use in patients with unrepaired and/or previously repaired or palliated congenital heart disease (children and adults), in patients with pediatric cardiomyopathies, and in pediatric patients with prior heart transplantation. Evidence-based guidelines for the indications for heart transplantation or retransplantation for these conditions were developed. Conclusions— This evaluation has led to the development and refinement of indications for heart transplantation for patients with congenital heart disease and pediatric cardiomyopathies in addition to indications for pediatric heart retransplantation.

show abstract

Section: Pulmonary Vascular Resistancementioning

confidence: 99%

Indications for Heart Transplantation in Pediatric Heart Disease

Canter¹,

Shaddy²,

Bernstein³

et al. 2007

Circulation

258

View full text Add to dashboard Cite

show abstract

“…Perioperative measures may be utilised to prevent rapid haemodynamic deterioration in the setting of right ventricular failure (RVF). These include the use of pulmonary vasodilator therapies to minimise right ventricular afterload [19,23,24], the avoidance of excessive fluid administration that may overload the right ventricle, maintaining appropriate systemic perfusion pressure for adequate coronary perfusion and enhancing myocardial contractility [25].…”

mentioning

confidence: 99%

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Price¹,

Montani²,

Jaïs³

et al. 2009

European Respiratory Journal

119

View full text Add to dashboard Cite

The anaesthetic management and follow-up of well-characterised patients with pulmonary arterial hypertension presenting for noncardiothoracic nonobstetric surgery has rarely been described.The details of consecutive patients and perioperative complications during the period January 2000 to December 2007 were reviewed. Repeat procedures in duplicate patients were excluded. Longer term outcomes included New York Heart Association (NYHA) functional class, 6-min walking distance and invasive haemodynamics.A total of 28 patients were identified as having undergone major (57%) or minor surgery under general (50%) and regional anaesthesia. At the time of surgery, 75% of patients were in NYHA functional class I-II. Perioperative deaths occurred in 7%. Perioperative complications, all related to pulmonary hypertension, occurred in 29% of all patients and in 17% of those with no deaths during scheduled procedures. Most (n511, 92%) of the complications occurred in the first 48 h following surgery. In emergencies (n54), perioperative complication and death rates were higher (100 and 50%, respectively; p,0.005). Risk factors for complications were greater for emergency surgery (p,0.001), major surgery (p50.008) and a long operative time (193 versus 112 min; p50.003). No significant clinical or haemodynamic deterioration was seen in survivors at 3-6 or 12 months of post-operative follow-up.Despite optimal management in this mostly nonsevere pulmonary hypertension population, perioperative complications were common, although survivors remained stable. Emergency procedures, major surgery and long operations were associated with increased risk.

show abstract

“…In addition, the pulmonary vascular response to INO has been studied as a part of the assessment for operability in patients with PH associated with congenital heart disease. [109][110][111][112] Those studies found that the combination of 100% oxygen and INO (at 80 ppm) produced maximal pulmonary vasodilation and was more predictive than either treatment alone for postoperative outcome. [109][110][111][112] Nitric Oxide-cGMP Cascade: PDE5 Inhibition.…”

Section: Nitric Oxide-cgmp Cascade: Inhaled Nitric Oxidementioning

confidence: 99%

“…[109][110][111][112] Those studies found that the combination of 100% oxygen and INO (at 80 ppm) produced maximal pulmonary vasodilation and was more predictive than either treatment alone for postoperative outcome. [109][110][111][112] Nitric Oxide-cGMP Cascade: PDE5 Inhibition. Sildenafil is a PDE5 inhibitor, so its mechanism of action is to augment nitric oxide-cGMP signaling by inhibiting the degradation of cGMP.…”

Section: Nitric Oxide-cgmp Cascade: Inhaled Nitric Oxidementioning

confidence: 99%

Advances in the Management of Pediatric Pulmonary Hypertension

2011

View full text Add to dashboard Cite

Pulmonary hypertension is a rare disease in neonates, infants, and children, and is associated with substantial morbidity and mortality. An adequate understanding of the controlling pathophysiologic mechanisms is lacking. Moreover, a minority of research is focused specifically on neonatal and pediatric populations. Although therapeutic options have increased over the past several decades, they remain limited. In advanced pulmonary hypertension, progressive pulmonary vascular functional and structural changes ultimately cause increased pulmonary vascular impedance, rightventricular failure, and death. Management includes the prevention and/or treatment of active pulmonary vasoconstriction, the support of right-ventricle function, treatment of the underlying disease (if possible), and the promotion of regressive remodeling of structural pulmonary vascular changes. Most currently available therapies augment or inhibit factors, or mediators of their downstream signaling cascades, that originate in the pulmonary vascular endothelium. These pathways include nitric-oxide/cyclic guanosine monophosphate (cGMP), prostacyclin, and endothelin-1. The ability to reverse advanced structural changes remains an as yet unattained goal. This paper reviews the epidemiology, pathophysiology, current treatments, and emerging therapies related to neonatal and pediatric pulmonary hypertension.

show abstract

Inhaled nitric oxide and hemodynamic evaluation of patients with pulmonary hypertension before transplantation

Abstract: These preliminary observations suggest that nitric oxide is a potent pulmonary vasodilator with minimal systemic effects. It may be useful in discriminating patients needing combined heart and lung transplantation from those requiring exchange of the heart alone.

Cited by 107 publications

References 48 publications

Indications for Heart Transplantation in Pediatric Heart Disease

Indications for Heart Transplantation in Pediatric Heart Disease

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Advances in the Management of Pediatric Pulmonary Hypertension

Contact Info

Product

Resources

About