Role of Nitroglycerin administration through inhalation route as Nitric oxide donor in decreasing pulmonary hypertension as consequence of non-cyanotic congenital heart defects in children candidate for diagnostic cardiac catheterization

Abstract

ABSTRACT Background: This work aimed to study nitroglycerin effect through inhalation route on pulmonary hemodynamics in children complaining from pulmonary hypertension associated withs noncyanotic congenital heart defects candidate for diagnostic cardiac catheterization. Methods: This prospective study had been carried out in Cardiac Catheterization Centre at El-Shatby Pediatric Alexandria University Hospital after approval of the medical ethical committee. Each parent had received verbal and plain language written explanation of the research protocol and informed consent had been taken from their parents. Eighteen children below twelve years old complaining noncyanotic congenital heart defects and left to right shunt with pulmonary hypertension who required diagnostic cardiac catheterization had participated prospectively in this research. After induction of anaesthesa, systemic and pulmonary pressures had been recorded for all patients invasively. Where pulmonary vascular resistance index and systemic vascular resistance index had been determined using standard formula based on Fick's principle through computerized program. Then patients received 2.5 µg/kg/min nitroglycerin through inhalation for 30 min. After that all measurements had been recorded again. Results: After nitroglycerin inhalational, mean, diastolic and systolic pulmonary pressures reduced significantly in comparison with their baseline data. Also, the PVRI had diminished from baseline data. No significate changes were recorded for systemic pressures and SVRI. Conclusion: Nitroglycerin inhalation decreased pulmonary pressures as well as pulmonary vascular resistance index, with no effect on systemic haemodynamics nor systemic vascular resistance index in kids with pulmonary hypertension as a consequence of noncyanotic congenital heart defects.