Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-27T18:30:03.430Z Has data issue: false hasContentIssue false
  • English
  • Français

Nitroglycerin inhalation for acute treatment of pulmonary arterial hypertension in children with congenital heart disease

Part of: Interventional Cardiology

Published online by Cambridge University Press:  04 June 2021

Eva Miranda Marwali Open the ORCID record for Eva Miranda Marwali [Opens in a new window] ,
Muhammad Rayhan  and
Poppy S. Roebiono
Eva Miranda Marwali*
Affiliation:
Pediatric Cardiac Intensive Care Division, National Cardiovascular, Center, Harapan Kita, Jakarta, Indonesia
Muhammad Rayhan
Affiliation:
Pediatric Cardiac Intensive Care Division, National Cardiovascular, Center, Harapan Kita, Jakarta, Indonesia
Poppy S. Roebiono
Affiliation:
Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia
*
Author for correspondence: Eva Miranda Marwali, MD, PhD, Pediatric Cardiac ICU Division, National Cardiovascular Center Harapan Kita Jl. Let. Jend. S. Parman, Kav 87, Slipi, West Jakarta, 11420, Indonesia. Mobile: (+62)813 8570 2548; Work: (62)21 5684085 ext. 2807; Fax: +62 21 5684230. E-mail: eva.marwali@pjnhk.goid
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Acute pulmonary hypertension and pulmonary hypertensive crisis may result in adverse clinical outcomes if unsuccessfully treated. Inhaled nitric oxide has long been considered as the standard pharmacotherapy for acute pulmonary hypertension, but lack of feasibility in some settings and evidences challenging its benefits lead to the use of alternative treatment, amongst which is nitroglycerin inhalation. The purpose of this review article is to discuss available data on the use of nitroglycerin inhalation for acute treatment of pulmonary hypertension in children with CHD and its potential benefit in post-operative setting.

Data sources:

Literatures included in this review were acquired by searching in PubMed online database. Keywords used were “Pulmonary Hypertension”, “Congenital heart defects”, “Pediatrics”, “Inhaled nitroglycerin”, and its synonyms.

Study selection:

Title and abstract were screened to select relevant literatures including the three paediatric clinical trials on nitroglycerin inhalation. Critical appraisal of the clinical trials was then done using the University of Oxford Centre of Evidence-Based Medicine Critical Appraisal Tools.

Conclusions:

Paediatric studies showed the benefit of nitroglycerin inhalation in uncorrected cases of CHD during catheterisation procedures. Until recently, there have been no studies conducted in paediatric post-operative CHD cases. Further study is required to provide evidence for inhaled nitroglycerin use in this setting including the appropriate dosing and potential side effects with repeated administration,

Keywords

Nitroglycerin inhalationaerosolised nitroglycerinexogenous nitric oxidepulmonary arterial hypertensioncongenital heart diseasecorrective surgery
Type
Review
Information
Cardiology in the Young , Volume 31 , Issue 9 , September 2021 , pp. 1381 - 1385
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hill, NS, Roberts, KR, Preston, IR. Postoperative pulmonary hypertension: etiology and treatment of a dangerous complication. Respir Care 2009; 54: 958–968.CrossRefGoogle ScholarPubMed
Bizzarro, M, Gross, I, Barbosa, FT. Inhaled nitric oxide for the postoperative management of pulmonary hypertension in infants and children with congenital heart disease. Cochrane Database Syst Rev 2014; 7: CD005055.CrossRefGoogle Scholar
Wong, J, Loomba, RS, Evey, L, et al. Postoperative inhaled nitric oxide does not decrease length of stay in pediatric cardiac surgery admissions. Pediatr Cardiol 2019; 40: 1559–1568.CrossRefGoogle Scholar
Hill, NS, Preston, IR, Roberts, KE. Inhaled therapies for pulmonary hypertension. Respir Care 2015; 60: 794–805.CrossRefGoogle ScholarPubMed
Chester, AH, Yacoub, MH, Moncada, S. Nitric oxide and pulmonary arterial hypertension. Glob Cardiol Sci Pract 2017; 2017: 14.Google ScholarPubMed
Bando, M, Ishii, Y, Kitamura, S, et al. Effects of inhalation of nitroglycerin on hypoxic pulmonary vasoconstriction. Respiration 1998; 65: 63–70.CrossRefGoogle ScholarPubMed
Kaestner, M, Schranz, D, Warnecke, G, et al. Pulmonary hypertension in the intensive care unit. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. Heart 2016; 102: ii57–ii66.CrossRefGoogle Scholar
Tulloh, RMR Congenital heart disease in relation to pulmonary hypertension in paediatric practice. Paediatr Respir Rev 2005; 6: 174–180.CrossRefGoogle ScholarPubMed
Brunner, N, Perez, J, Richter, A, et al. Perioperative pharmacological management of pulmonary hypertensive crisis during congenital hert surgery. Pulm Circ 2014; 4: 10–24.CrossRefGoogle Scholar
Suesaowalak, M, Cleary, JP, Chang, AC. Advances in diagnosis and treatment of pulmonary arterial hypertension in neonates and children with congenital heart disease. World J Pediatr 2010; 6: 13–31.CrossRefGoogle ScholarPubMed
Bando, K, Turrentine, MW, Sharp, TG, et al. Pulmonary hypertension after operations for congenital heart disease: analysis of risk factors and management. J Thorac Cardiovasc Surg 1996; 112: 1600–1609.CrossRefGoogle ScholarPubMed
Zamanian, RT, Haddad, F, Doyle, RL, et al. Management strategies for patients with pulmonary hypertension in the intensive care unit. Crit Care Med 2007; 35: 2037–2050.CrossRefGoogle ScholarPubMed
Dong, MF, Ma, ZS, Ma, SJ, et al. Effect of prostaglandin E1 on pulmonary arterial hypertension following corrective surgery for congenital heart disease. J Cardiovasc Pharmacol Ther 2012; 17: 303–307.CrossRefGoogle ScholarPubMed
Kermode, J, Butt, W, Shann, F. Comparison between prostaglandin E1 and epoprostenol (prostacyclin) in infants after heart surgery. Br Heart J 1991; 66: 175–178.CrossRefGoogle ScholarPubMed
Yamauchi, H, Yamaki, S, Fujii, M, et al. Reduction in recalcitrant pulmonary hypertension after operation for atrial septal defect. Ann Thorac Surg 2001; 72: 905–907.CrossRefGoogle ScholarPubMed
Frost, AE, Quinones, MA, Zoghbi, WA, et al. Reversal of pulmonary hypertension and subsequent repair of atrial septal defect after treatment with continuous intravenous epoprostenol. J Heart Lung Transplant 2005; 24: 501–503.CrossRefGoogle ScholarPubMed
Abman, SH, Hansmann, G, Archer, SL, et al. Pediatric pulmonary hypertension guidelines from the American Heart Association and American Thoracic Society. Circulation 2015; 132: 2037–2099.CrossRefGoogle ScholarPubMed
Wessel, DL, Adatia, I, Thompson, JE, et al. Delivery and monitoring of inhaled nitric oxide in patients with pulmonary hypertension. Crit Care Med 1994; 22: 930–938.CrossRefGoogle ScholarPubMed
Macrae, DJ, Field, D, Mercier, JC, et al. Inhaled nitric oxide therapy in neonates and children: reaching a European consensus. Intensive Care Med 2004; 30: 372–380.CrossRefGoogle ScholarPubMed
Germann, P, Braschi, A, Della, RG, et al. Inhaled nitric oxide therapy in adults: European expert recommendations. Intensive Care Med 2005; 31: 1029–1041.CrossRefGoogle ScholarPubMed
Russell, IA, Zwass, MS, Fineman, JR, et al. The effects of inhaled nitric oxide on postoperative pulmonary hypertension in infants and children undergoing surgical repair of congenital heart disease. Anesth Analg 1998; 87: 46–51.CrossRefGoogle ScholarPubMed
Miller, OI, Tang, SF, Keech, A, et al. Inhaled nitric oxide and prevention of pulmonary hypertension after congenital heart surgery: a randomised double-blind study. Lancet 2000; 356: 1464–1469.CrossRefGoogle ScholarPubMed
Journois, D, Baufreton, C, Mauriat, P, et al. Effects of inhaled nitric oxide administration on early postoperative mortality in patients operated for correction of atrioventricular canal defects. Chest 2005; 128: 3537–3544.CrossRefGoogle ScholarPubMed
Ilbawi, MN, Idriss, FS, DeLeon, SY, et al. Hemodynamic effects of intravenous nitroglycerin in pediatric patients after heart surgery. Circulation 1985; 72: II101–II107.Google ScholarPubMed
Pearl, RG, Rosenthal, MH, Schroeder, JS, et al. Acute hemodynamic effects of nitroglycerin in pulmonary hypertension. Ann Intern Med 1983; 99: 9–13.CrossRefGoogle ScholarPubMed
Omar, H, Gong, F, Sun, MY, et al. Nebulized nitroglycerin in children with pulmonary hypertension secondary to congenital heart disease. W V Med J 1999; 95: 74–75.Google ScholarPubMed
Goyal, P, Kiran, U, Chauhan, S, et al. Efficacy of nitroglycerin inhalation in reducing pulmonary arterial hypertension in children with congenital heart disease. Br J Anaesth 2006; 97: 208–214.CrossRefGoogle ScholarPubMed
Singh, R, Choudhury, M, Saxena, A, et al. Inhaled nitroglycerin versus inhaled milrinone in children with congenital heart disease suffering from pulmonary artery hypertension. J Cardiothorac Vasc Anesth 2010; 24: 797–801.CrossRefGoogle ScholarPubMed
Yurtseven, S, Karaca, P, Kaplan, M, et al. Effect of Nitroglycerin Inhalation on Patients with pulmonary hypertension undergoing mitral valve replacement surgery. Anasthesiology 2003; 99: 855–858.CrossRefGoogle ScholarPubMed
Yurtseven, N, Karaca, P, Uysal, G, et al. A Comparison of the acute hemodynamic effects of inhaled nitroglycerin and iloprost in patients with pulmonary hypertension undergoing mitral valve surgery. Ann Thorac Cardiovasc Surg 2006; 12: 319–323.Google ScholarPubMed
Mandal, B, Kapoor, PM, Chowdhury, U, et al. Acute hemodynamic effects of inhaled nitroglycerine, intravenous nitroglycerine, and their combination with intravenous dobutamine in patients with secondary pulmonary hypertension. Ann Card Anaesth 2010; 13: 138–144.CrossRefGoogle ScholarPubMed
Fikry, DM, Ramadan, ME, Elhadedy, MS, et al. Comparison of hemodynamic effects of inhaled milrinone and inhaled nitroglycerin in patients with pulmonary hypertension undergoing mitral valve surgery. Res Opin Anesth Intensive Care 2017; 4: 35–39.Google Scholar