Document Detail

Nitric oxide in conjunction with milrinone better stabilized pulmonary hemodynamics after Fontan procedure.
MedLine Citation:
PMID:  18959679     Owner:  NLM     Status:  MEDLINE    
Inhaled nitric oxide (iNO) has been used for patients with increased pulmonary vascular resistance (PVR) shortly after Fontan operation, but repeat deterioration of PVR during or shortly after its withdrawal remains a major concern. Milrinone, a phosphodiesterase type 3 (PDE3) inhibitor, can also reduce PVR for postoperative patients with pulmonary hypertension. We hypothesized that iNO, in conjunction with milrinone, can provide additive benefits for pulmonary hemodynamics and reduce the occurrence of iNO withdrawal failure/rebound. Thirty-one patients with marked elevation of transpulmonary pressure gradient (TPG, >10 mm Hg) or central venous pressure (CVP, >15 mm Hg) after modified fenestrated Fontan operation were prospectively randomized into two groups, that is, group iNO (iNO at approximately 10 ppm, n = 15) and group iNO + Mil (iNO at approximately 10 ppm and milrinone at 0.5 microg/kg/min, n = 16). Hemodynamics, arterial blood oxygenation, and occurrence of withdrawal failure/rebound were compared between the two groups. Combined application of iNO and milrinone resulted in (i) more significant decrement of CVP (19.6 +/- 3.5% in group iNO + Mil vs. 15.2 +/- 4.6% in group iNO, P < 0.05) and TPG (18.2 +/- 4.8% in group iNO + Mil vs. 15.3 +/- 2.6% in group iNO, P < 0.05), (ii) more significant increment of systolic systemic arterial pressure (8.7 +/- 2.7% in group iNO + Mil vs. 5.2 +/- 3.1% in group iNO, P < 0.05), and (iii) more significant improvement of arterial oxygen saturation (9.3 +/- 3.2% in group iNO + Mil vs. 6.8 +/- 2.8% in group iNO, P < 0.01). Occurrence of iNO withdrawal failure during its weaning or rebound after its discontinuation was significantly lower in group iNO + Mil. The combined use of iNO and milrinone provided additive benefits as compared with exclusive use of iNO for patients with elevated PVR after Fontan procedure.
Jiming Cai; Zhaokang Su; Zhenying Shi; Yanping Zhou; Zhiwei Xu; Jinfen Liu; Ling Chen; Zhuoming Xu; Xiaoqing Yu; Wenxiang Ding; Yanmin Yang
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Artificial organs     Volume:  32     ISSN:  1525-1594     ISO Abbreviation:  Artif Organs     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-30     Completed Date:  2008-12-12     Revised Date:  2009-01-24    
Medline Journal Info:
Nlm Unique ID:  7802778     Medline TA:  Artif Organs     Country:  United States    
Other Details:
Languages:  eng     Pagination:  864-9     Citation Subset:  IM    
Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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MeSH Terms
Administration, Inhalation
Blood Pressure / drug effects
Child, Preschool
Drug Therapy, Combination
Fontan Procedure*
Hemodynamics / drug effects*
Hypertension, Pulmonary / drug therapy,  surgery
Milrinone / therapeutic use*
Nitric Oxide / therapeutic use*
Treatment Outcome
Vascular Resistance*
Vasodilator Agents / therapeutic use*
Reg. No./Substance:
0/Vasodilator Agents; 10102-43-9/Nitric Oxide; 78415-72-2/Milrinone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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