Original articleInhaled Nitroglycerin Versus Inhaled Milrinone in Children with Congenital Heart Disease Suffering from Pulmonary Artery Hypertension
Section snippets
Materials and Methods
After approval from the institute's ethics committee and written informed consent from the parents, 40 children (age < 12 years) with acyanotic CHD (left-to-right intracardiac shunt) with moderate or severe PAH (defined by mean PAP > 30 mmHg) were enrolled in the study. Patients with associated mitral valve disease, severe pulmonary or tricuspid regurgitation, obstructive lesions, severe left ventricular dysfunction, and those already receiving vasodilator treatments were excluded from the
Results
The demographics and the clinical diagnosis of the patients receiving milrinone (group M, n = 18) and nitroglycerin (group N, n = 17) were similar (Table 1). Hemodynamic variables in group M and group N are shown in Table 2, Table 3, respectively. After drug nebulization or treatment with oxygen, both groups did not reveal any significant changes in heart rate, systolic, diastolic and mean systemic arterial pressures, RAPs and PCWP while compared with their baseline values. However, the
Discussion
The results of this study demonstrated that in patients with congenital heart disease and pulmonary artery hypertension, both inhaled milrinone and inhaled nitroglycerin led to significant decreases in systolic, diastolic, and mean pulmonary artery pressures. The drugs also cause a decrease in PVRI and SVRI, but the effect on SVRI is small compared with the effect on PVRI, highlighting a more selective effect on pulmonary vasculature when given through the inhaled route. These acute changes
Conclusion
Both milrinone and nitroglycerin given via the inhaled route significantly decrease systolic, diastolic and mean PAPs as well as PVRI without significant effects on systemic hemodynamics. Both drugs given via the inhaled route offer a good therapeutic choice to address pulmonary artery hypertensive episodes in perioperative settings. Additional studies are needed to define the optimal dosing range for both drugs via the inhalation route to treat children with severe pulmonary artery
Acknowledgment
The authors thank M. Kalaivani, PhD, scientist, for her assistance in the statistical analysis of the data.
References (14)
- et al.
Nitroglycerin therapy in management of pulmonary hypertensive disorders
Am J Med
(1984) - et al.
Inhaled nitric oxide: Therapeutic applications in cardiothoracic surgery
Ann Thorac Surg
(1996) - et al.
Nitric oxide, cell signaling, and cell death
Toxicolgy
(2005) - et al.
Efficacy of nitroglycerin inhalation in reducing pulmonary artery hypertension in children with congenital heart disease
Br J Anesth
(2006) - et al.
Hemodynamic effects of milrinone during weaning from CPB: Comparison of patients with a low and high prebypass cardiac index
J Cardiothorac Vasc Anesth
(2000) - et al.
Effects of nitroglycerin inhalation on patients with pulmonary hypertension undergoing mitral valve replacement surgery
Anesthesiology
(2003) - et al.
Preliminary experience with inhaled milrinone in cardiac surgery
Eur J Cardiothorac Surg
(2007)