VARIABLE RESPONSE TO INHALED NITRIC OXIDE IN POSTOPERATIVE PATIENTS OF MITRAL STENOSIS WITH PULMONARY HYPERTENSION
AbstractBackground: This study was carried out to determine the vasodilator response of inhaled nitric oxidein 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 ForcesInstitute of Cardiology (AFIC) in collaboration with Department of Physiology, Army MedicalCollege, Rawalpindi from March 2004 to February 2006. Thirty patients with systolic PulmonaryArtery Pressure (PAP) >50 mmHg on pre-operative echocardiography were inducted. Swan Ganzcatheter was inserted to record baseline pulmonary artery pressure and pulmonary capillary wedgepressure (PCWP), while cardiac output (CO) was recorded through lithium dilution method. PulmonaryVascular Resistance (PVR) was calculated with the help of a formula. Inhaled nitric oxide (iNO) wasadministered 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 isolatedmitral stenosis and 9 had mixed mitral and aortic valve disease. 22 patients responded significantly toiNO therapy with ≥40.0% reduction in their baseline PVR while 8 patients showed insignificantimprovement 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 highpressures despite iNO therapy in non-responders indicate that apart from some abnormality in nitricoxide pathway, some other factors may be a contributing in the causation of PH secondary to mitralstenosis in adults, which warrant further studies.Keywords: Nitric Oxide, mitral stenosis, pulmonary hypertension, pulmonary artery pressure,pulmonary vascular resistance
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