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BJA Advance Access originally published online on May 17, 2006
British Journal of Anaesthesia 2006 97(2):208-214; doi:10.1093/bja/ael112
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Efficacy of nitroglycerin inhalation in reducing pulmonary arterial hypertension in children with congenital heart disease

P. Goyal1,*, U. Kiran1, S. Chauhan1, R. Juneja2 and M. Choudhary1

1 Department of Cardiac Anaesthesiology, Cardio Thoracic Centre, All India Institute of Medical Sciences New Delhi 110029, India
2 Department of Cardiology, Cardio Thoracic Centre, All India Institute of Medical Sciences New Delhi 110029, India

*Corresponding author: Department of Cardiac Anaesthesiology, 7th Floor, Cardio Thoracic Centre, All India Institute of Medical Sciences, New Delhi 110029, India. E-mail: princeofcoma{at}yahoo.co.uk

Background. There has been a renewed interest in nitric oxide donor drugs, such as nitroglycerin, delivered by the inhalational route for treatment of pulmonary arterial hypertension (PAH). We investigated the acute effects of inhaled nitroglycerin on pulmonary and systemic haemodynamics in children with PAH associated with congenital heart disease.

Methods. Nineteen children with acyanotic congenital heart disease and a left to right shunt with severe PAH, undergoing routine diagnostic cardiac catheterization were included in this study. Systolic, diastolic and mean systemic as well as pulmonary artery pressures, right atrial pressure and pulmonary capillary wedge pressure (PCWP) were recorded and systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) were calculated at room air, following 100% oxygen as well as after nitroglycerin inhalation in all patients.

Results. Systolic, diastolic and mean pulmonary artery pressure and PVRI decreased significantly, whereas heart rate, systolic, diastolic and mean systemic arterial pressure, PCWP and SVRI did not change significantly following 100% oxygen or inhalation of nitroglycerin.

Conclusion. Inhaled nitroglycerin significantly decreases systolic, diastolic and mean pulmonary artery pressure as well as PVRI without affecting systemic haemodynamics, and thus can be used as a therapeutic modality for acute reduction of PAH in children with congenital heart disease.


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INHALATIONAL NITROGLYCERINE AND PULMONARY HYPERTENSION
K.R RAMANATHAN, et al.
British Journal of Anaesthesia, 8 Aug 2006 [Full text]
reply to e-letter in response to our article in BJA
Dr Puneet Goyal, et al.
British Journal of Anaesthesia, 25 Aug 2006 [Full text]

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