Hemodynamic effects of inhaled nitric oxide and phosphodiesterase inhibitor (dipyridamole) on secondary pulmonary hypertension following heart valve surgery in adults
| Autor: | Gianluca Casali, Stefano Auriemma, Mario Lusini, Francesco Santini, Gianluigi Franchi, Antonio Messina, Alessandro Favaro, Luca Barozzi, Alessandro Mazzucco |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Male
medicine.medical_specialty Mean arterial pressure Pulmonary Circulation Nitric oxide Pulmonary hypertension Dipyridamole Cardiac surgery Phosphodiesterase Inhibitors Hypertension Pulmonary Cardiac index Heart Valve Diseases Nitric Oxide Oxygen Consumption Internal medicine medicine.artery Administration Inhalation medicine Humans Heart valve Prospective Studies Pulmonary Wedge Pressure Cardiac Output Aged Heart Valve Prosthesis Implantation Analysis of Variance business.industry Middle Aged medicine.disease Bronchodilator Agents medicine.anatomical_structure Treatment Outcome Pulmonary valve Anesthesia Aortic Valve Pulmonary artery Vascular resistance Cardiology Mitral Valve Drug Therapy Combination Female Vascular Resistance Cardiology and Cardiovascular Medicine business |
| Zdroj: | International journal of cardiology. 103(2) |
| ISSN: | 0167-5273 |
| Popis: | Inhaled nitric oxide (iNO) is proposed in the management of pulmonary hypertension (PH) in patients undergoing cardiac surgery. Secondary PH related to a long-standing heart valve disease however may be refractory to iNO. Aim of this prospective study was to determine whether the combination of iNO plus dipyridamole (DP), a cyclic guanosine monophosphate-specific phosphodiesterase inhibitor (PDE5), may enhance and/or prolong the response to iNO in adult patients with secondary valve-related PH undergoing cardiac surgery, and attenuate rebound events related to its discontinuation.Responses in 27 patients, 11 male, mean age 72+/-11 years, with PH due to mitral and/or aortic valve disease, were studied in the Intensive Care Unit after cardiac surgery, during sedation and stable hemodynamic conditions. The effect of isolated iNO administration (40 ppm), iNO combined with DP (0.2 mg/kg i.v.), and DP alone (1 mg/kg/24 h) on pulmonary vascular resistance, mean pulmonary artery pressure, cardiac index, mixed venous O2Sat%, and mean arterial pressure were determined.All patients showed at least a 10% decrease in pulmonary vascular resistance vs. baseline after administration of iNO [responders]. Inhaled NO and the combination of iNO/DP produced a reduction of pulmonary vascular resistance and mean pulmonary artery pressure (p0.05). Cardiac index improved with a significant difference between iNO and the association iNO/DP versus baseline (p0.05). This significant hemodynamic improvement versus baseline was maintained during isolated DP administration (p0.05), but not during isolated iNO discontinuation. Mixed venous oxygen saturation showed an overall improvement of 17% (p0.05).Inhaled NO and DP infusion might represent a valuable association in the management of PH secondary to a heart valve disease in patients undergoing cardiac surgery. Their beneficial hemodynamic effects might be particularly valuable in the management of patients with associated right ventricular dysfunction. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect