VARIABLE RESPONSE TO INHALED NITRIC OXIDE IN POSTOPERATIVE PATIENTS OF MITRAL STENOSIS WITH PULMONARY HYPERTENSION

Zubia Razzaq, Muhammad Aslam, M Mazhar Hussain, Shahab Naqvi, Muhammad Zameer, Ahmed Badar

Abstract


Background: This study was carried out to determine the vasodilator response of inhaled nitric oxide
in patients with pulmonary hypertension (PH) after valve replacement surgery for mitral valve disease.
Method: This Quesi experimental study was carried out at the intensive care unit of Armed Forces
Institute of Cardiology (AFIC) in collaboration with Department of Physiology, Army Medical
College, Rawalpindi from March 2004 to February 2006. Thirty patients with systolic Pulmonary
Artery Pressure (PAP) >50 mmHg on pre-operative echocardiography were inducted. Swan Ganz
catheter was inserted to record baseline pulmonary artery pressure and pulmonary capillary wedge
pressure (PCWP), while cardiac output (CO) was recorded through lithium dilution method. Pulmonary
Vascular Resistance (PVR) was calculated with the help of a formula. Inhaled nitric oxide (iNO) was
administered after the surgery and the same parameters were recorded again after one hour. Results:
The majority of patients were females (73%), while males were only 27%. Out of 30, 21 had isolated
mitral stenosis and 9 had mixed mitral and aortic valve disease. 22 patients responded significantly to
iNO therapy with ≥40.0% reduction in their baseline PVR while 8 patients showed insignificant
improvement in their PVR (663±233 dynes.sec.cm-5 to 605±222 dynes.sec.cm-5). Conclusion:
Significant improvement in pulmonary vascular resistance in the responders and maintenance of high
pressures despite iNO therapy in non-responders indicate that apart from some abnormality in nitric
oxide pathway, some other factors may be a contributing in the causation of PH secondary to mitral
stenosis in adults, which warrant further studies.
Keywords: Nitric Oxide, mitral stenosis, pulmonary hypertension, pulmonary artery pressure,
pulmonary vascular resistance

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