Clinical Research in Cardiology

, Volume 100, Issue 7, pp 595–602

Comparison of inhaled nitric oxide with aerosolized iloprost for treatment of pulmonary hypertension in children after cardiopulmonary bypass surgery

  • Tsvetomir Loukanov
  • Dietrich Bucsenez
  • Wolfgang Springer
  • Christian Sebening
  • Helmut Rauch
  • Eva Roesch
  • Matthias Karck
  • Matthias Gorenflo
Original Paper

DOI: 10.1007/s00392-011-0284-5

Cite this article as:
Loukanov, T., Bucsenez, D., Springer, W. et al. Clin Res Cardiol (2011) 100: 595. doi:10.1007/s00392-011-0284-5

Abstract

Objectives

Pilot study to compare the effect of inhaled nitric oxide (iNO) and aerosolized iloprost in preventing perioperative pulmonary hypertensive crises (PHTCs).

Background

Guidelines recommend the use of iNO to treat PHTCs, but treatment with iNO is not an ideal vasodilator. Aerosolized iloprost may be a possible alternative to iNO in this setting.

Methods

Investigator-initiated, open-label, randomized clinical trial in 15 infants (age range 77–257 days) with left-to-right shunt (11 out of 15 with additional trisomy 21), and pulmonary hypertension (i.e. mean pulmonary artery pressure [PAP] >25 mmHg) after weaning from cardiopulmonary bypass. Patients were randomized to treatment with iNO at 10 ppm or aerosolized iloprost at 0.5 µg/kg (every 2 h). The observation period was 72 h after weaning from cardiopulmonary bypass. The primary endpoint was the occurrence of PHTCs; the secondary endpoints were mean PAP, duration of mechanical ventilation, safety of administration, and in-hospital mortality.

Results

Seven patients received iNO and eight patients received iloprost. During the observation period, 13 of the 15 patients had at least one major or minor PHTC. There was no difference between the groups with regard to the frequency of PHTCs, mean PAP and duration of mechanical ventilation (p > 0.05).

Conclusions

In this pilot study, aerosolized iloprost had a favorable safety profile. Larger trials are needed to compare its efficacy to iNO for the treatment of perioperative pulmonary hypertension. However, neither treatment alone abolished the occurrence of PHTCs.

Keywords

Congenital heart disease Surgery Pulmonary hypertension Children 

Abbreviations

iNO

Inhaled nitric oxide

FiO2

Fraction of inspired oxygen

Qp/Qs

Ratio of pulmonary to systemic blood flow

PaCO2

Partial arterial pressure of carbon dioxide

PaO2

Partial arterial pressure of oxygen

PAP

Pulmonary arterial pressure

Pp/Ps

Ratio of pulmonary to systemic blood pressure

ppm

Parts per million

PVR

Pulmonary vascular resistance

PHTC

Pulmonary hypertensive crisis

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Tsvetomir Loukanov
    • 1
  • Dietrich Bucsenez
    • 2
  • Wolfgang Springer
    • 2
  • Christian Sebening
    • 1
  • Helmut Rauch
    • 3
  • Eva Roesch
    • 2
  • Matthias Karck
    • 1
  • Matthias Gorenflo
    • 2
  1. 1.Department of Cardiac SurgeryUniversity of Heidelberg Medical CentreHeidelbergGermany
  2. 2.Department of Pediatric CardiologyUniversity Medical CenterHeidelbergGermany
  3. 3.Department of AnesthesiologyUniversity Medical CenterHeidelbergGermany

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