Inhaled nitric oxide in patients with critical pulmonary perfusion after fontan-type procedures and bidirectional glenn anastomosis

Abstract

Objective: The aim of this study was to evaluate the effects of inhaled nitric oxide in patients with critical pulmonary perfusion after Fontan-type procedures and bidirectional Glenn anastomosis. Methods: Inhaled nitric oxide (mean 4.1 ± 0.7 ppm, 1.5 to 10 ppm) was administered in 13 patients (mean age 5.6 ± 1.6 years, 1.5 to 17 years) with critical pulmonary perfusion (central venous pressure >20 mm Hg or transpulmonary pressure gradient >10 mm Hg) in the early postoperative period after total cavopulmonary connection ( n = 9) or after bidirectional Glenn anastomosis ( n = 4). Results: In patients after total cavopulmonary connection inhaled nitric oxide therapy decreased central venous pressure by 15.3% ± 1.4% ( p = 0.0001) and transpulmonary pressure gradient by 42% ± 8% ( p = 0.0008) and increased mean systemic arterial and left atrial pressures by 12% ± 3.6% ( p = 0.011) and 28% ± 8% ( p = 0.007), respectively. Arterial and venous oxygen saturations improved by 8.2% ± 1% ( p = 0.005) and 14% ± 4.3% ( p = 0.03), respectively. In patients after bidirectional Glenn anastomosis inhaled nitric oxide therapy resulted in a decrease of central venous pressure by 22% ± 1% and of the transpulmonary pressure gradient by 55% ± 6% and improved arterial and venous oxygen saturations by 37% ± 29% and 11% ± 3%, respectively. Mean systemic arterial and left atrial pressures remained nearly unchanged. No toxic side effect was observed in Conclusion: Inhaled nitric oxide may play an important role in the management of transient critical pulmonary perfusion caused by reactive elevated pulmonary vascular resistance in the early postoperative period after Fontan-type operations and bidirectional Glenn anastomosis. (J Thorac Cardiovasc Surg 1997;113:435-42)