Curative effect of nitric oxide and bosentan on treatment of the interruption of aortic arch with ventricular septal defect and serious pulmonary hypertension: A randomized controlled study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONG Hailong , TAO Shuguang , YANG Shihai , WEN Linlin , JIN Lichen ,  WANG Jianming

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

Corresponding?author：

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

Keywords：

Interruption of aortic arch; severe pulmonary hypertension; nitric oxide; bosentan

DOI：

10.7507/1007-4848.201710030

Video：

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Objective To analyze the curative effect of nitric oxide (NO) and bosentan on treatment of the interruption of aortic arch (IAA) with ventricular septal defect (VSD) and serious pulmonary hypertension (SPH). Methods Thirty-two children with IAA and VSD combined SPH from January 2015 to May 2017 confirmed by cardiac CT and ultrasound in Children’s Hospital of Hebei Province were enrolled including 17 males and 15 females, aged 1.10-4.30 months (mean, 2.71±0.98 months) and weighing 3.33-6.10 kg (mean, 4.57±0.88 kg). The 32 children were randomly divided into two groups (n=16 in each), a NO group and a bosentan group. All the patients underwent interruption of aortic arch and ventricular septal defect repair. When patients returned to cardiosurgery intensive care unit (CSICU) half an hour later, patients in the NO group inhaled NO 20 ppm for 36 h and those in the bosentan group were given bosentan by nasogastric feeding 15 mg, twice a day. The cardic index, pulmonary/systemic pressure ratio, oxygenation index at 3 h, 6 h, 12 h, 24 h, 36 h after surgery were evaluated, and the differences between the two groups were compared. Results The pulmonary/systemic pressure ratio in the two groups increased at first and then decreased, while oxygenation index in the two groups decreased at first and then increased, and the differences in the same groups at the adjacent time points were statistically significant (P<0.05). The cardiac index in the two groups decreased at first and then increased, the differences in the same groups at the adjacent time points were statistically significant, except for 6 h and 12 h after surgery in the bosentan group (P>0.05). At postoperative 6 h, 12 h, the oxygenation index in the NO group was significantly higher than that in the bosentan group, and the pulmonary/systemic pressure ratio in the NO group was less than that in the bosentan group (P<0.01). The cardiac index in the NO group was higher than that of the bosentan group after 6 h, 12 h, 24 h of operation, which were statistically significant (P<0.05), and the cardic index of children in the NO group was greatly higher than that in the bosentan group after 12 h of surgery (P<0.01); at the same time point, the corresponding indexes were not statistically significant between the two groups (P>0.05). Conclusion NO inhalation in the treatment of IAA with VSD and SPH in children with early postoperative SPH is better than the bosentan, but in the late postoperative period, the effect is similar.

Citation： SONG Hailong, TAO Shuguang, YANG Shihai, WEN Linlin, JIN Lichen, WANG Jianming. Curative effect of nitric oxide and bosentan on treatment of the interruption of aortic arch with ventricular septal defect and serious pulmonary hypertension: A randomized controlled study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(10): 839-843. doi: 10.7507/1007-4848.201710030 Copy

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3.	EK Ozer, AB Iskit. Effects of endothelin and nitric oxide on cardiac muscle functions in experimental septic shock model. Hum Exp Toxicol, 2016, 35(3): 267-275.
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8.	張玉振, 李玉峰, 趙宏俊. 波生坦片聯合西地那非治療兒童左向右分流型先天性心臟病術后殘留肺動脈高壓 31 例臨床評價. 中國藥業, 2015, 24(5): 14-15.
9.	Abman SH, Hansmann G, Archer SL, et al. Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation, 2015, 132(21): 2037-2099.
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11.	戴海龍, 魯一兵, 光雪峰, 等. 波生坦在先天性心臟病合并肺動脈高壓患者中的應用進展. 中國循環雜志, 2016, 31(2): 206-208.
12.	Voerman JS, Remerie S, Westendorp T, et al. Effects of a guided Internet-delivered self-help intervention for adolescents with chronic pain. J Pain, 2015, 15(11): 1115-1126.
13.	王麗, 汪佩, 李巖鵬, 等. 17β- 雌二醇和 2- 甲氧基雌二醇對慢性低氧性肺動脈高壓大鼠體內內皮素-1/一氧化氮體系的影響. 中國循環雜志, 2016, 31(5): 489-494.
14.	Steinhorn RH, Kusic-Pajic A, Cornelisse P, et al. Bosentan as adjunctive therapy for persistent pulmonary hypertension of the newborn: results of the randomized multicenter placebo-controlled exploratory trial. J Pediatr, 2016, 177: 90-96.

1. Jonas RA. Management of interrupted aortic arch. Semin Thorac Cardiovasc Surg, 2015, 27(2): 177-188.
2. 黃亞軍, 胡志偉, 董念國, 等. 端側吻合與人工血管矯治嬰兒主動脈弓離斷早、中期療效比較. 臨床外科雜志, 2017, 25(5): 352-355.
3. EK Ozer, AB Iskit. Effects of endothelin and nitric oxide on cardiac muscle functions in experimental septic shock model. Hum Exp Toxicol, 2016, 35(3): 267-275.
4. Lakshminrusimha S, Mathew B, Leach CL. Pharmacologic strategies in neonatal pulmonary hypertension other than nitric oxide. Semin Perinatol, 2016, 40(3): 160-173.
5. 李霞, 李守軍, 王旭, 等. 吸入一氧化氮聯合西地那非治療全腔靜脈肺動脈連接術后早期肺動脈高壓臨床安全性的觀察. 心肺血管病雜志, 2015, 34(11): 825-829.
6. Milger K, Felix JF, Voswinckel R, et al. Sildenafil versus nitric oxide for acute vasodilator testing in pulmonary arterial hypertension. Pulm Circ, 2015, 5(2): 305-312.
7. 朱興旺, 朱小冰. 吸入一氧化氮治療新生兒持續性肺動脈高壓研究進展. 中國新生兒雜志, 2015, 30(3): 236-240.
8. 張玉振, 李玉峰, 趙宏俊. 波生坦片聯合西地那非治療兒童左向右分流型先天性心臟病術后殘留肺動脈高壓 31 例臨床評價. 中國藥業, 2015, 24(5): 14-15.
9. Abman SH, Hansmann G, Archer SL, et al. Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation, 2015, 132(21): 2037-2099.
10. Lakshminrusimha S, Konduri GG, Steinhorn RH. Considerations in the management of hypoxemic respiratory failure and persistent pulmonary hypertension in term and late preterm neonates. J Perinatol, 2016, 36(Suppl 2): S12-S19.
11. 戴海龍, 魯一兵, 光雪峰, 等. 波生坦在先天性心臟病合并肺動脈高壓患者中的應用進展. 中國循環雜志, 2016, 31(2): 206-208.
12. Voerman JS, Remerie S, Westendorp T, et al. Effects of a guided Internet-delivered self-help intervention for adolescents with chronic pain. J Pain, 2015, 15(11): 1115-1126.
13. 王麗, 汪佩, 李巖鵬, 等. 17β- 雌二醇和 2- 甲氧基雌二醇對慢性低氧性肺動脈高壓大鼠體內內皮素-1/一氧化氮體系的影響. 中國循環雜志, 2016, 31(5): 489-494.
14. Steinhorn RH, Kusic-Pajic A, Cornelisse P, et al. Bosentan as adjunctive therapy for persistent pulmonary hypertension of the newborn: results of the randomized multicenter placebo-controlled exploratory trial. J Pediatr, 2016, 177: 90-96.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Curative effect of nitric oxide and bosentan on treatment of the interruption of aortic arch with ventricular septal defect and serious pulmonary hypertension: A randomized controlled study

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