Original articles: CardiovascularRandomized controlled study of inhaled nitric oxide after operation for congenital heart disease
Section snippets
Material and methods
This study was approved by the Research and Human Subjects Committee of Primary Children’s Medical Center (July 29, 1993). Informed consent was obtained from the patients (≥ 18 years of age) or their parents. An Investigational New Drug application for the use of inhaled nitric oxide for postoperative pulmonary hypertension was approved by the US Food and Drug Administration (March 12, 1993). This study was performed from August 1993 to August 1999.
Patients
Nineteen patients were enrolled into each patient group. Two patients were enrolled on two separate occasions; both underwent operation for pulmonary venous obstruction after an initial repair of total anomalous pulmonary venous return. The patients’ diagnoses are listed in Table 1. A similar number of patients had Down syndrome in each group. Table 1 also indicates that several patients in each group had radiographic evidence of lung disease before operation. The median age was 6 months
Comment
In this study, nitric oxide did not acutely improve pulmonary hemodynamics and arterial blood gases in comparison to conventional therapy. Nitric oxide also failed to significantly decrease the incidence of pulmonary hypertensive crises. This study is clearly limited by its size; however, it provides an estimate of the number of patients needed to exclude, with greater power, the possibility that inhaled nitric oxide prevents clinically significant pulmonary hypertensive crises after operation
Acknowledgements
We thank each member of the Department of Respiratory Care Services at Primary Children’s Medical Center who assisted in the delivery of inhaled nitric oxide.
References (21)
- et al.
Preoperative pulmonary hemodynamics and early mortality after orthotopic cardiac transplantationthe Pittsburg experience
Am Heart J
(1993) - et al.
Pulmonary vasodilatory effects of 12 and 60 parts per million inhaled nitric oxide in children with ventricular septal defect
Am J Cardiol
(1995) - et al.
Inhaled nitric oxide in patients with normal and increased pulmonary vascular resistance after cardiac surgery
Br J Anaesth
(1994) - et al.
Inhaled nitric oxide as a therapy for pulmonary hypertension after operations for congenital heart defects
J Thorac Cardiovasc Surg
(1994) - et al.
Very low-dose inhaled nitric oxidea selective pulmonary vasodilator after operations for congenital heart disease
J Thorac Cardiovasc Surg
(1994) - et al.
Inhaled nitric oxide for children with congenital heart disease and pulmonary hypertension
Ann Thorac Surg
(1995) - et al.
Nitric oxide might reduce the need for extracorporeal support in children with critical postoperative pulmonary hypertension
Ann Thorac Surg
(1996) - et al.
Diagnostic use of inhaled nitric oxide after neonatal cardiac operations
J Thorac Cardiovasc Surg
(1996) - et al.
Right ventricular function in patients treated with inhaled nitric oxide after cardiac surgery for congenital heart disease in newborns and children
Am J Cardiol
(1997) - et al.
Delivery of inhaled nitric oxide using the Ohmeda INOvent Delivery System
Chest
(1998)
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