Effect of inhaling NO perioperatively on postoperative cardiac and pulmonary functions in infants with congenital ventricular septal defect complicated with severe pulmonary hypertension: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONG Hailong , WEN Linlin , YANG Shihai , TAO Shuguang , HAN Jiangang , JIN Lichen ,  WANG Jianming , CAO Lijing

Department of Cardiac Surgery, Children’s Hospital of Hebei Province, Shijiazhuang, 050031, P.R.China;

Corresponding?author：

WANG Jianming, Email: wang-li-w@yahoo.com

Keywords：

Congenital ventricular septal defect; pulmonary hypertension; nitric oxide; cardiac index; oxygenation index; troponin

DOI：

10.7507/1007-4848.201608045

Video：

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Objective To investigate the effect of low-flow inhaling NO for short time on postoperative cardiac and pulmonary functions in infants with congenital ventricular septal defect complicated with severe pulmonary hypertension. Methods Forty-five patients with congenital ventricular septal defect complicated with severe pulmonary hypertension from May 2014 to May 2016 in our hospital were enrolled. There were 19 males and 26 females, whose age ranged from 1 to 22 months (average age: 7.2±14.4 months) and weight ranged from 2.7 to 10.5 kg (average weight: 6.8±3.6 kg). The patients were randomly divided into three groups (n=15 in each): the blank group, the prior inhalation group and the posterior inhalation group. The blank group did not inhale NO, and the prior inhalation group inhalated NO for 10 min after tracheal and intubation. After the opening of the aorta, the posterior inhalation group inhaled NO for 10 min. The concentration of NO was 20 × 10^–6. The pressure ratio of pulmonary circulation/systematic circulation, heart index and oxygenation index were calculated and the troponin value of the three groups was monitored 10 min after returning to intensive care unit (ICU) and postoperatively 1 h, 3 h and 24 h. Differences among above indicators between three groups were compared. Results The troponin value of the posterior inhalation group within 3 h increased most, followed by the blank group and the prior inhalation group. Postoperatively 1 h and 3 h, the troponin value of the prior inhalation group was significantly less than that of the blank group and posterior inhalation group (P<0.01) and the value on postoperative 24 h in each group was lower than that on postoperative 3 h. The cardiac index of prior inhalation group was higher than that of the blank group and the posterior inhalation group at each time point. Postoperatively 3 h and 24 has well as 10 min after returning to ICU, the cardiac index in prior inhalation group was significantly higher than that of the posterior inhalation group (P<0.05). The pressure ratio of pulmonary circulation/systematic circulation of posterior inhalation group increased more than that of blank group; the differences in two groups were significant between postoperative 3 h and 10 min after returning to ICU (P<0.01). There was no statistical significance in the pressure ratio on postoperative 24 h and 10 min after returning to ICU (P>0.05) in three groups. The index of oxygenation of the prior inhalation group was higher than that of the blank group and the posterior inhalation group and statistically different from that of posterior inhalation group (P<0.05). Conclusion Inhaling NO 10 min preoperatively can reduce the injury to the heart and lung function effectively, but the result is the opposite when inhalating NO 10 min after aorta opening.

Citation： SONG Hailong, WEN Linlin, YANG Shihai, TAO Shuguang, HAN Jiangang, JIN Lichen, WANG Jianming, CAO Lijing. Effect of inhaling NO perioperatively on postoperative cardiac and pulmonary functions in infants with congenital ventricular septal defect complicated with severe pulmonary hypertension: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(7): 501-505. doi: 10.7507/1007-4848.201608045 Copy

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3.	Nguyen HV, Havalad V, Aponte-Patel L, et al. Temporary biventricular pacing decreases the vasoactive-inotropic score after cardiac surgery: a substudy of a randomized clinical trial. J Thorac Cardiovasc Surg, 2013, 146(2): 296-301.
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9.	陳小慧. 新生兒持續肺動脈高壓病理機制及治療進展. 中華實用兒科臨床雜志, 2014, 29(14): 1041-1043.
10.	Latus H, Delhass T, Schranz D, et al. Treatment of pulmonary arterial hypertension in children. Nat Rev Cardiol, 2015, 12(4): 244-254.
11.	Antoniou T, Koletsis EN, Prokakis C, et al. Hemodynamic effects of combination therapy with inhaled nitric oxide and iloprost in patients with pulmonary hypertension and right ventricular dysfunction after high-risk cardiac surgery. J Cardiothorac Vasc Anesth, 2013, 27(3): 459-466.
12.	Antoniou T, Prokakis C, Athanasopoulos G, et al. Inhaled nitric oxide plus iloprost in the setting of post-left assist device right heart dysfunction. Ann Thorac Surg, 2012, 94(3): 792-798.
13.	董力杰, 張蕾, 蘆菲, 等. 肺保護性通氣策略聯合一氧化氮吸入治療小兒重癥肺炎合并急性呼吸窘迫綜合征 10 例報道. 中國小兒急救醫學, 2014, 21(1): 41-42.
14.	Ahmet K, Yalim Y, Nursen T, et al. Comparison of inhaled nitric oxide and aerosolized iloprost in pulmonary hypertension in children with congenital heart surgery. Cardiol J, 2012, 19(4): 387-394.
15.	鄭志坤, 李勁松, 胡輝, 等. 短時長吸入一氧化氮預處理對大鼠肺缺血再灌注損傷的保護作用. 中華實驗外科雜志, 2012, 29(8): 1500-1502.
16.	成夢遇, 宓亞平, 桂永浩, 等. 吸入一氧化氮和伊洛前列腺素治療嬰幼兒先天性心臟病術后中重度肺動脈高壓的隨機對照研究. 中華實用兒科臨床雜志, 2015, 30(13): 1004-1007.

1. Klinger JR, Abman SH, Gladwin MT, et al. Nitric oxide deficiency and endothelial dysfunction in pulmonary arterial hypertension. Am J Respir Crit Care Med, 2013, 188(6): 639-646.
2. Magdalena JS, Daria OM. The current approach into signaling pathways in pulmonary arteral hypertension and their implication in novel therapeutic strategies. Pharmacol Rep, 2014, 66(4): 552-564.
3. Nguyen HV, Havalad V, Aponte-Patel L, et al. Temporary biventricular pacing decreases the vasoactive-inotropic score after cardiac surgery: a substudy of a randomized clinical trial. J Thorac Cardiovasc Surg, 2013, 146(2): 296-301.
4. Ivy DD, Abman SH, Barst RJ, et al. Pediatric pulmonary hypertension. J Am Coll Cardiol, 2013, 62(Suppl 25): S117-S126.
5. 朱雄凱, 柯雪琴, 俞建根, 等. 小兒先天性心臟病重度肺高壓手術后遠期療. 中華小兒外科雜志2003, 24(4): 314-316.
6. 齊宇潔, 劉靖媛, 吳海蘭, 等. 不同年代新生兒肺動脈高壓的臨床病因分析. 中國小兒急救醫學, 2014, 21(6): 369-372.
7. 高偉, 顧紅, 胡大一, 等. 2015 年先天性心臟病相關性肺動脈高壓診治中國專家共. 中國介入心臟病學雜志, 2015, 23(2): 61-68.
8. Kirbas A, Yalcin Y, Tanrikulu N, et al. Comparison of inhaled nitric oxide and aerosolized iloprost in pulmonary hypertension in children with congenital heart surgery. Cardiol J, 2012, 19(4): 387-394.
9. 陳小慧. 新生兒持續肺動脈高壓病理機制及治療進展. 中華實用兒科臨床雜志, 2014, 29(14): 1041-1043.
10. Latus H, Delhass T, Schranz D, et al. Treatment of pulmonary arterial hypertension in children. Nat Rev Cardiol, 2015, 12(4): 244-254.
11. Antoniou T, Koletsis EN, Prokakis C, et al. Hemodynamic effects of combination therapy with inhaled nitric oxide and iloprost in patients with pulmonary hypertension and right ventricular dysfunction after high-risk cardiac surgery. J Cardiothorac Vasc Anesth, 2013, 27(3): 459-466.
12. Antoniou T, Prokakis C, Athanasopoulos G, et al. Inhaled nitric oxide plus iloprost in the setting of post-left assist device right heart dysfunction. Ann Thorac Surg, 2012, 94(3): 792-798.
13. 董力杰, 張蕾, 蘆菲, 等. 肺保護性通氣策略聯合一氧化氮吸入治療小兒重癥肺炎合并急性呼吸窘迫綜合征 10 例報道. 中國小兒急救醫學, 2014, 21(1): 41-42.
14. Ahmet K, Yalim Y, Nursen T, et al. Comparison of inhaled nitric oxide and aerosolized iloprost in pulmonary hypertension in children with congenital heart surgery. Cardiol J, 2012, 19(4): 387-394.
15. 鄭志坤, 李勁松, 胡輝, 等. 短時長吸入一氧化氮預處理對大鼠肺缺血再灌注損傷的保護作用. 中華實驗外科雜志, 2012, 29(8): 1500-1502.
16. 成夢遇, 宓亞平, 桂永浩, 等. 吸入一氧化氮和伊洛前列腺素治療嬰幼兒先天性心臟病術后中重度肺動脈高壓的隨機對照研究. 中華實用兒科臨床雜志, 2015, 30(13): 1004-1007.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of inhaling NO perioperatively on postoperative cardiac and pulmonary functions in infants with congenital ventricular septal defect complicated with severe pulmonary hypertension: A randomized controlled trial

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