ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
Hemodynamic effects of inhaled nitric oxide used in pulmonary thromboendarterectomy operations
Meliha Zeynep Kahraman Karataş1, Füsun Güzelmeriç1, Bedrettin Yıldızeli3, Korhan Erkanlı2, Atakan Erkılınç1, Pınar Karaca Baysal1, Hayat Carus4, Tuncer Koçak1
Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye
1Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Anestezi ve Reanimasyon Kliniği, İstanbul, Türkiye
2İstanbul Mehmet Akif Ersoy Göğüs Kalp Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul, Türkiye
3Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Göğüs Cerrahisi Kliniği, İstanbul, Türkiye
4İstanbul Mehmet Akif Ersoy Göğüs Kalp Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Anestezi ve Reanimasyon Kliniği, İstanbul, Türkiye
DOI : 10.5606/tgkdc.dergisi.2014.9147
Background: This study aims to evaluate the hemodynamic effects of inhaled nitric oxide (iNO) in patients with chronic thromboembolic pulmonary hypertension who are undergoing pulmonary endarterectomy.

Methods: A total of 25 patients (ASA I-II) who were planned to undergo operation due to chronic thromboembolic pulmonary hypertension were included in the study. Patients were divided into two groups (group 1 and group 2). Inhaled nitric oxide at 20 ppm was given to patients in group 1 (n=13) and group 2 (n=12) after induction. Pulmonary artery (PA) pressure, central venous pressure, heart rate, systolic arterial pressure, PA wedge pressure, cardiac index, and pulmonary vascular resistance (PVR) were recorded at minutes 10 (T1) and 30 (T2), after perfusion (T3), and while sternal closure (T4).

Results: In group 1 and group 2, PA mean systolic and diastolic pressures, and PVR were significantly lower compared to the initial period (T0) (p<0.05). In group 1, cardiac index was significantly higher in T1, T2, T3, and T4 compared to T0 (p<0.05). Mean PA pressure in both groups was statistically significantly lower than the initial value. While no difference was observed in both groups between T0 and T1 periods, mean PA pressure was statistically significantly lower in other periods in group 1 (p=0.008). In group 1, mean PA pressure was significantly lower in T1, T2, T3, and T4 periods with respect to baseline value. In group 2, while a significant reduction was detected in T1 period compared to baseline value, a significant reduction was detected in T3 and T4 periods compared to T1 period (p=0.04). Although no significant differences were observed in PVR between the groups during T0 and T1 periods, PVR was significantly lower in group 1 in T2, T3, and T4 periods (p=0.03).

Conclusion: We suggest that iNO is one of the most appropriate pulmonary vasodilator agents due to its pharmacological properties without causing adverse hemodynamic changes in thrombendarterectomy operations for chronic pulmonary hypertension patients.

Keywords : Inhaled nitric oxide; pulmonary hypertension; pulmonary thromboendarterectomy
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