Intraoperative NO therapy of patients having high pulmonary hypertension when correcting valve cardiac disorders

V.V. Pichugin, S.E. Domnin, M.L. Kalinina, A.P. Medvedev, A.V. Bogush, V.A. Chiginev, A.B. Gamzayev, S.A. Zhurko
Keywords: inhaled NO therapy, high pulmonary hypertension, cardiac valves operations.
Medicinskij al'manah, 2017, issue 3, pages 144-149.

The aim of the study was to evaluate the effectiveness of permanent inhaled NO therapy during heart valves
surgery with CPB in patients with high pulmonary hypertension. Material and methods. The study included
71 patients of both sexes, mean age 58,9±1,9 who underwent heart valve surgery or combined interventions.
The mean pulmonary artery pressure was 42,2±1,5 mm Hg. All patients were divided into three groups: the
first (27 patients) – control; the second (24 patients) – pulmonary artery perfusion/lungs ventilation during
the CPB were performed; the third (20 patients) – patients received inhalation of NO from transferring to
ventilation during the entire operation in combination with pulmonary artery perfusion/lungs ventilation during
CPB. A comparative evaluation included changes in the functional parameters of the lungs, the study of central
hemodynamic, and myocardial contractility function. Results. Intraoperative inhaled NO therapy in patients
with high pulmonary hypertension was accompanied by a significantly lower alveolar-arterial oxygen difference
during operation, a significantly higher oxygenation index from the start of NO inhalation, and a higher
level at the end of the operative intervention, significantly lower the level of F-shunt after CPB and the preservation
of the initial values of lungs compliance at all stages of the operation. The onset of NO inhalation
resulted in a significant decrease in mean pulmonary artery pressure, an average of 18,0%, with preserved
rates of myocardial contractility of the left ventricle. No adverse effects of inhalation of NO were noted, such
as the formation of a toxic metabolite of NO2 above the maximum level (2–5 ppm), the formation of methaemoglobin
greater than 1.5%, and the toxic effect of high concentrations of NO. Conclusion. The use of
combined technology with constant NO inhalation and pulmonary perfusion/lungs ventilation during CPB has
several undeniable advantages than the isolated perfusion/ventilation technique during CPB.

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V.V. Pichugin, S.E. Domnin, M.L. Kalinina, A.P. Medvedev, A.V. Bogush, V.A. Chiginev, A.B. Gamzayev, S.A. Zhurko Intraoperative NO therapy of patients having high pulmonary hypertension when correcting valve cardiac disorders. Medicinskij al'manah 2017; (3): 144–149, http://dx.doi.org/10.21145/2499-9954-2017-3-144-149