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Ann Thorac Surg 1995;60:300-305
© 1995 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Nitric Oxide Is Superior to Prostacyclin for Pulmonary Hypertension After Cardiac Operations

Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom

Background. Severe pulmonary hypertension is still a cause of morbidity and mortality in children after cardiac operations. The objective of this study was to compare the vasodilator properties of inhaled nitric oxide, a novel pulmonary vasodilator, and intravenous prostacyclin in the treatment of severe postoperative pulmonary hypertension.

Methods. Thirteen children (aged 3 days to 12 months) with severe pulmonary hypertension after cardiac operations were given inhaled nitric oxide (20 ppm x 10 minutes) and intravenous prostacyclin (20 ng • kg^-1 • min^-1 x 10 minutes) in a prospective, randomized cross-over study.

Results. Both nitric oxide and prostacyclin resulted in a reduction in pulmonary arterial pressure, although the mean pulmonary arterial pressure was significantly lower during nitric oxide therapy (28.5 ± 2.9 mm Hg) than during prostacyclin therapy (35.4 ± 2.1 mm Hg; p < 0.05). The mean pulmonary to systemic arterial pressure ratio was also significantly lower during nitric oxide than prostacylin administration (0.46 ± 0.04 versus 0.68 ± 0.05; p < 0.01), due mainly to only prostacyclin lowering systemic blood pressure.

Conclusions. Inhaled nitric oxide was a more effective and selective pulmonary vasodilator than prostacyclin and should be considered as the preferred treatment for severe postoperative pulmonary hypertension.

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Discussion
Ann. Thorac. Surg. 1995 60: 306. [Extract] [Full Text]

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