Echocardiographic evidence of improved hemodynamics during inhaled nitric oxide therapy for persistent pulmonary hypertension of the newborn

Pediatric Cardiology
C G OchikuboM Kanakriyeh

Abstract

To evaluate the cardiovascular effects of inhaled nitric oxide (NO) on the systemic and pulmonary circulations, 25 consecutive infants with severe persistent pulmonary hypertension of the newborn (PPHN) underwent serial echocardiographic evaluations before and during inhaled NO therapy. Estimation of the systolic pulmonary artery pressure (SPAP) was derived from measurement of a tricuspid regurgitant jet using Bernoulli's equation. We also derived a pulmonary/systemic pressure ratio to evaluate overall cardiopulmonary effects. Paired measurements of estimated SPAP decreased from 62.0 +/- 3.8 mmHg to 44.7 +/- 4.3 mmHg (p < 0.01) during inhaled NO therapy. The pulmonary/systemic pressure ratio decreased from 0.98 +/- 0.06 to 0.59 +/- 0.04 during NO therapy (p < 0.01), indicating a significant decline in the vascular resistance between the two circulations. These changes also correlated with changes in the extrapulmonary shunt patterns at the ductus arteriosus and foramen ovale seen during inhaled NO therapy. The decreased right-to-left shunting was accompanied by a parallel (64%) improvement in systemic oxygenation, with the alveolar-arterial oxygen gradient (A-a DO2) falling from 591 +/- 14 mmHg to 380 +/- 33 mmHg (p < 0.01). We...Continue Reading

Citations

Nov 6, 2008·Pediatric Surgery International·Tadaharu OkazakiAtsuyuki Yamataka
Apr 19, 2011·Pediatric Surgery International·Toshiaki TakahashiTadaharu Okazaki
Feb 9, 2000·Pharmacology & Therapeutics·B WeinbergerJ D Laskin
Sep 29, 2005·Acta Paediatrica·Milad El-SegaierGöran Wettrell
Apr 7, 2015·Seminars in Fetal & Neonatal Medicine·Amish Jain, Patrick J McNamara
Aug 18, 2004·Annals of Saudi Medicine·Saleh Al-AlaiyanKhalid Attas

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