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The Annals of Thoracic Surgery, Vol 57, 1311-1318, Copyright © 1994 by The Society of Thoracic Surgeons
I Adatia, C Lillehei, JH Arnold, JE Thompson, R Palazzo, JC Fackler and DL Wessel
Pulmonary hypertension and transient graft dysfunction may complicate the
postoperative course of patients undergoing lung transplantation. We report
the acute effect of inhaled nitric oxide (80 ppm) on hemodynamics and gas
exchange in 6 patients (median age, 14 years; range, 5 to 21 years) after
lung transplantation as well as the effect of extended treatment over 40 to
69 hours in 2 patients. In 5 patients with pulmonary hypertension nitric
oxide lowered mean pulmonary artery pressure (from 38.4 +/- 1.6 to 29.4 +/-
3.1 mm Hg; p < 0.05), pulmonary vascular resistance index (from 9.3 +/-
1.4 to 6.4 +/- 1.3 Um2; p < 0.05), and intrapulmonary shunt fraction
(from 28.6% +/- 8.3% to 21.0% +/- 5.7%; p < 0.05). There was a 28.4% +/-
7.2% reduction in transpulmonary pressure gradient with only minor
accompanying effects on the systemic circulation. Mean arterial pressure
decreased only 2.7% +/- 5% (from 76.4 +/- 2.2 to 74 +/- 2.3 mm Hg; p = not
significant), and systemic vascular resistance index by 4.2% +/- 9.7% (from
21.7 +/- 3.1 to 20.6 +/- 3.6 Um2; p = not significant). Cardiac index was
unchanged (from 3.5 +/- 0.8 to 3.6 +/- 0.7 L.min-1.m-2; p = not
significant). Nitric oxide caused a sustained improvement in oxygenation
and pulmonary artery pressure during extended therapy at doses of 10 ppm.
There were no major side effects. However, transient methemoglobinemia (9%)
developed in 1 patient after 10 hours of nitric oxide treatment. Nitric
oxide may be useful in the treatment of pulmonary hypertension and the
impaired gas exchange that occurs after lung transplantation.
ARTICLES
Inhaled nitric oxide in the treatment of postoperative graft dysfunction after lung transplantation
Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115.
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