Effect of nitroglycerin inhalation on patients with pulmonary hypertension undergoing mitral valve replacement surgery

• Published in: Anesthesiology (Philadelphia) 2003-10, Vol.99 (4), p.855-858
• Main Authors: YURTSEVEN, Nurgul, KARACA, Pelin, KAPLAN, Mehmet, OZKUL, Vedat, TUYGUN, Abdullah K, AKSOY, Tamer, CANIK, Sevim, KOPMAN, Ercument
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Adult; Biological and medical sciences; Cardiovascular system; Female; Hemodynamics - drug effects; Hemodynamics - physiology; Humans; Hypertension, Pulmonary - drug therapy; Hypertension, Pulmonary - physiopathology; Male; Medical sciences; Middle Aged; Mitral Valve Insufficiency - drug therapy; Mitral Valve Insufficiency - surgery; Mitral Valve Stenosis - drug therapy; Mitral Valve Stenosis - surgery; Nitroglycerin - administration & dosage; Pharmacology. Drug treatments; Vascular Resistance - drug effects; Vascular Resistance - physiology; Vasodilator agents. Cerebral vasodilators
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/00000542-200310000-00017

The aim of this study was to investigate the postoperative hemodynamic effects of nitroglycerin inhalation on patients with pulmonary hypertension undergoing mitral valve replacement surgery. Twenty patients who underwent mitral valve replacement surgery were included in the study. In the surgical intensive care unit, at T0 (before the inhalation of nitroglycerin), basal systemic and pulmonary hemodynamics were recorded. Then, 2.5 microg x kg-1 x min-1 nitroglycerin liquid nebulized by a 2-l gas flow of 40% oxygen and air mixture was administered to the patients who were diagnosed as having pulmonary hypertension (mean pulmonary arterial pressures > 25 mmHg). The same parameters were measured at the first (T1), third (T2), and fifth (T3) hours after the beginning of this treatment and 1 h after the end of nitroglycerin inhalation (T4). There were no statistically significant differences at T0, T1, T2, T3, or T4 with respect to heart rate, mean arterial pressure, systemic vascular resistance, cardiac index, mixed venous oxygen saturation, arteriovenous oxygen content difference, or arterial carbon dioxide tension. However, mean pulmonary artery pressure, pulmonary vascular resistance, and intrapulmonary shunt fraction were significantly lower, and the arterial oxygen tension/fraction of inspired oxygen ratio was higher at T1, T2, and T3 when compared to that of T0 and T4. The results suggest that nitroglycerin inhalation produces a significant reduction in both mean pulmonary artery pressure and pulmonary vascular resistance in patients after mitral valve operations without reducing mean arterial pressure and systemic vascular resistance. Therefore, it might be a safe and useful therapeutic intervention during the postoperative course.