Zubia Razzaq, M, Mazhar Hussain, Shahab Naqvi, Mohammad Aslam


Background: Variable response to inhaled nitric oxide (iNO) therapy in patients with mitral stenosis
(MS) having pulmonary hypertension (PH) has been documented in early studies. The objectives of this
study were to measure plasma Endothelin-1 (ET-1) levels in those patients and to correlate them with
pulmonary vascular indices after iNO therapy. It was Quesi-experimental study. Methods: Thirty
patients with mitral or mixed mitral and aortic valve disease with severe pulmonary hypertension and
enrolled for valve replacement surgery were included. Before the replacement, baseline pulmonary
vascular indices and cardiac output were recorded. After the surgery, 10–20 ppm iNO was administered
for 1 hour and all the parameters were again recorded. Patients were grouped into responders and non
responders on the basis of % reduction in Pulmonary Vascular Resistance (PVR) after iNO therapy.
Plasma ET-1 levels were measured in both groups by ELISA before and after the iNO therapy. Paired
sample t-test was used to compare mean values for significance. The correlations between variables
were then calculated by using Pearson’s coefficient. Results: The plasma ET-1 levels were very high in
all patients. They reduced in responders after iNO therapy; non-responders paradoxically showed
significant increase in the levels of ET-1 after iNO therapy. Moreover, a positive correlation was
observed in plasma ET-1 levels and post operative levels of PVR. Conclusion: The correlation of
changes in PVR and plasma ET-1 levels in responders suggests that high plasma ET-1 is a key
mediator of poor response in PH secondary to MS, after iNO therapy.
Keywords: Mitral Stenosis, Pulmonary Hypertension, Inhaled Nitric Oxide

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