Abstract | BACKGROUND: METHODS AND RESULTS: A total of 15 children with congenital heart disease and PHT who had elevated pulmonary vascular resistance (preoperative, n=10; immediately postoperative, n=5) were first given 20 ppm of iNO for 10 minutes; then, after baseline values were reached again, they were given aerosolized iloprost at 25 ng. kg(-1). min(-1) for another 10 minutes. Finally, iNO and iloprost were given simultaneously for 10 minutes. With iNO, the pulmonary vascular resistance and systemic vascular resistance ratio decreased from 0.48+/-0.38 to 0.27+/-0.16 (P:<0.001). Similarly, iloprost decreased the ratio from 0.49+/-0.38 to 0.26+/-0.11 (P:<0.05). The combination had no additional effect on the resistance ratio. Plasma cGMP increased from 17.6+/-11.9 to 34.7+/-21.4 nmol/L during iNO (P:<0.01), and plasma cAMP increased from 55.7+/-22.9 to 65.1+/-21.2 nmol/L during iloprost inhalation (P:<0.05). CONCLUSIONS: In children with PHT and congenital heart disease, both iNO and aerosolized iloprost are equally effective in selectively lowering pulmonary vascular resistance through an increase in cGMP or cAMP, respectively. However, the combination of both vasodilators failed to prove more potent than either substance alone. Aerosolized iloprost might be an alternative to iNO for early testing of vascular reactivity and for the postoperative treatment of acute PHT.
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Authors | P C Rimensberger, I Spahr-Schopfer, M Berner, E Jaeggi, A Kalangos, B Friedli, M Beghetti |
Journal | Circulation
(Circulation)
Vol. 103
Issue 4
Pg. 544-8
(Jan 30 2001)
ISSN: 1524-4539 [Electronic] United States |
PMID | 11157720
(Publication Type: Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Aerosols
- Vasodilator Agents
- Nitric Oxide
- Cyclic AMP
- Cyclic GMP
- Iloprost
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Topics |
- Administration, Inhalation
- Aerosols
- Analysis of Variance
- Child
- Child, Preschool
- Cyclic AMP
(blood)
- Cyclic GMP
(blood)
- Heart Defects, Congenital
(complications)
- Hemodynamics
(drug effects)
- Humans
- Hypertension, Pulmonary
(drug therapy, etiology, physiopathology)
- Iloprost
(administration & dosage)
- Infant
- Lung
(blood supply, drug effects, physiopathology)
- Nitric Oxide
(administration & dosage)
- Pulmonary Circulation
(drug effects)
- Vascular Resistance
(drug effects)
- Vasodilator Agents
(administration & dosage)
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