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Hemodynamic effects of inhaled nitric oxide and phosphodiesterase inhibitor (dipyridamole) on secondary pulmonary hypertension following heart valve surgery in adults.
Int J Cardiol. 2005 Aug 18; 103(2):156-63.IJ

Abstract

BACKGROUND

Inhaled nitric oxide (iNO) is proposed in the management of pulmonary hypertension (PH) in patients undergoing cardiac surgery. Secondary PH related to a long-standing heart valve disease however may be refractory to iNO. Aim of this prospective study was to determine whether the combination of iNO plus dipyridamole (DP), a cyclic guanosine monophosphate-specific phosphodiesterase inhibitor (PDE5), may enhance and/or prolong the response to iNO in adult patients with secondary valve-related PH undergoing cardiac surgery, and attenuate rebound events related to its discontinuation.

METHODS

Responses in 27 patients, 11 male, mean age 72+/-11 years, with PH due to mitral and/or aortic valve disease, were studied in the Intensive Care Unit after cardiac surgery, during sedation and stable hemodynamic conditions. The effect of isolated iNO administration (40 ppm), iNO combined with DP (0.2 mg/kg i.v.), and DP alone (1 mg/kg/24 h) on pulmonary vascular resistance, mean pulmonary artery pressure, cardiac index, mixed venous O2Sat%, and mean arterial pressure were determined.

RESULTS

All patients showed at least a 10% decrease in pulmonary vascular resistance vs. baseline after administration of iNO [responders]. Inhaled NO and the combination of iNO/DP produced a reduction of pulmonary vascular resistance and mean pulmonary artery pressure (p<0.05). Cardiac index improved with a significant difference between iNO and the association iNO/DP versus baseline (p<0.05). This significant hemodynamic improvement versus baseline was maintained during isolated DP administration (p<0.05), but not during isolated iNO discontinuation. Mixed venous oxygen saturation showed an overall improvement of 17% (p<0.05).

CONCLUSIONS

Inhaled NO and DP infusion might represent a valuable association in the management of PH secondary to a heart valve disease in patients undergoing cardiac surgery. Their beneficial hemodynamic effects might be particularly valuable in the management of patients with associated right ventricular dysfunction.

Authors+Show Affiliations

Division of Cardiac Surgery and Anesthesiology, University of Verona, OCM Borgo Trento, Piazzale Stefani 1, 37126, Verona, Italy. fsant@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16080974

Citation

Santini, Francesco, et al. "Hemodynamic Effects of Inhaled Nitric Oxide and Phosphodiesterase Inhibitor (dipyridamole) On Secondary Pulmonary Hypertension Following Heart Valve Surgery in Adults." International Journal of Cardiology, vol. 103, no. 2, 2005, pp. 156-63.
Santini F, Casali G, Franchi G, et al. Hemodynamic effects of inhaled nitric oxide and phosphodiesterase inhibitor (dipyridamole) on secondary pulmonary hypertension following heart valve surgery in adults. Int J Cardiol. 2005;103(2):156-63.
Santini, F., Casali, G., Franchi, G., Auriemma, S., Lusini, M., Barozzi, L., Favaro, A., Messina, A., & Mazzucco, A. (2005). Hemodynamic effects of inhaled nitric oxide and phosphodiesterase inhibitor (dipyridamole) on secondary pulmonary hypertension following heart valve surgery in adults. International Journal of Cardiology, 103(2), 156-63.
Santini F, et al. Hemodynamic Effects of Inhaled Nitric Oxide and Phosphodiesterase Inhibitor (dipyridamole) On Secondary Pulmonary Hypertension Following Heart Valve Surgery in Adults. Int J Cardiol. 2005 Aug 18;103(2):156-63. PubMed PMID: 16080974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemodynamic effects of inhaled nitric oxide and phosphodiesterase inhibitor (dipyridamole) on secondary pulmonary hypertension following heart valve surgery in adults. AU - Santini,Francesco, AU - Casali,Gianluca, AU - Franchi,Gianluigi, AU - Auriemma,Stefano, AU - Lusini,Mario, AU - Barozzi,Luca, AU - Favaro,Alessandro, AU - Messina,Antonio, AU - Mazzucco,Alessandro, PY - 2004/04/06/received PY - 2004/08/03/revised PY - 2004/08/07/accepted PY - 2005/8/6/pubmed PY - 2006/9/22/medline PY - 2005/8/6/entrez SP - 156 EP - 63 JF - International journal of cardiology JO - Int J Cardiol VL - 103 IS - 2 N2 - BACKGROUND: Inhaled nitric oxide (iNO) is proposed in the management of pulmonary hypertension (PH) in patients undergoing cardiac surgery. Secondary PH related to a long-standing heart valve disease however may be refractory to iNO. Aim of this prospective study was to determine whether the combination of iNO plus dipyridamole (DP), a cyclic guanosine monophosphate-specific phosphodiesterase inhibitor (PDE5), may enhance and/or prolong the response to iNO in adult patients with secondary valve-related PH undergoing cardiac surgery, and attenuate rebound events related to its discontinuation. METHODS: Responses in 27 patients, 11 male, mean age 72+/-11 years, with PH due to mitral and/or aortic valve disease, were studied in the Intensive Care Unit after cardiac surgery, during sedation and stable hemodynamic conditions. The effect of isolated iNO administration (40 ppm), iNO combined with DP (0.2 mg/kg i.v.), and DP alone (1 mg/kg/24 h) on pulmonary vascular resistance, mean pulmonary artery pressure, cardiac index, mixed venous O2Sat%, and mean arterial pressure were determined. RESULTS: All patients showed at least a 10% decrease in pulmonary vascular resistance vs. baseline after administration of iNO [responders]. Inhaled NO and the combination of iNO/DP produced a reduction of pulmonary vascular resistance and mean pulmonary artery pressure (p<0.05). Cardiac index improved with a significant difference between iNO and the association iNO/DP versus baseline (p<0.05). This significant hemodynamic improvement versus baseline was maintained during isolated DP administration (p<0.05), but not during isolated iNO discontinuation. Mixed venous oxygen saturation showed an overall improvement of 17% (p<0.05). CONCLUSIONS: Inhaled NO and DP infusion might represent a valuable association in the management of PH secondary to a heart valve disease in patients undergoing cardiac surgery. Their beneficial hemodynamic effects might be particularly valuable in the management of patients with associated right ventricular dysfunction. SN - 0167-5273 UR - https://www.unboundmedicine.com/medline/citation/16080974/Hemodynamic_effects_of_inhaled_nitric_oxide_and_phosphodiesterase_inhibitor__dipyridamole__on_secondary_pulmonary_hypertension_following_heart_valve_surgery_in_adults_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(05)00004-5 DB - PRIME DP - Unbound Medicine ER -