Inhaled NO After Congenital Heart Surgery Reduces Risk of Pulmonary Hypertension

WESTPORT, CT (Reuters Health) – In infants undergoing surgery to correct congenital heart defects, the routine use of inhaled nitric oxide (NO) can reduce the risk of pulmonary hypertensive crisis, and shorten the postoperative course, according to a report by Australian researchers.

Dr. Owen I. Miller, from Prince of Wales Hospital, Randwick, Australia, and a multicenter team randomly selected 124 infants, median age 3 months, who underwent corrective surgery for congenital heart disease, to receive continuous low-dose inhaled nitric oxide or placebo. The patients remained on therapy from the time of surgery until they were extubated, according to the investigators’ report the October 28th issue of The Lancet.

“Compared with placebo, infants receiving inhaled nitric oxide had fewer pulmonary hypertensive crises (median four vs seven…) and shorter times until criteria for extubation were met (80 vs 112 hours),” according to Dr. Miller and colleagues. They add that there were no toxic effects noted among the nitric oxide group.

The investigators note that even though the frequency of pulmonary hypertensive crises was reduced in infants receiving nitric oxide it was not eliminated. They suggest that “this may have been due to an insufficient dose of inhaled nitric oxide.”

“Nevertheless, the clinical implication is that routine prophylactic use of inhaled nitric oxide at 10 parts per million will reduce the frequency of major pulmonary hypertensive crises and lessen time to extubation eligibility by 1 day or more,” Dr. Miller and colleagues conclude. They also point out that using nitric oxide is not complicated, and “easy for staff to understand and monitor.”

Lancet 2000;356:1464-1469.

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