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Oral prostacyclin enhances the pulmonary vasodilatory effect of nitric oxide in children with pulmonary hypertension

Published online by Cambridge University Press:  19 August 2008

Kei-ichiro Uese ,
Fukiko Ichida ,
Shin-ichi Tsubata ,
Ikuo Hashimoto ,
Yuji Hamamichi ,
Kazuaki Fukahara ,
Arata Murakami  and
Toshio Miyawaki
Kei-ichiro Uese
Affiliation:
Department of Pediatrics and the First Division of Surgery, Toyama Medical & Pharmaceutical University, Toyama, Japan
Fukiko Ichida*
Affiliation:
Department of Pediatrics and the First Division of Surgery, Toyama Medical & Pharmaceutical University, Toyama, Japan
Shin-ichi Tsubata
Affiliation:
Department of Pediatrics and the First Division of Surgery, Toyama Medical & Pharmaceutical University, Toyama, Japan
Ikuo Hashimoto
Affiliation:
Department of Pediatrics and the First Division of Surgery, Toyama Medical & Pharmaceutical University, Toyama, Japan
Yuji Hamamichi
Affiliation:
Department of Pediatrics and the First Division of Surgery, Toyama Medical & Pharmaceutical University, Toyama, Japan
Kazuaki Fukahara
Affiliation:
Department of Pediatrics and the First Division of Surgery, Toyama Medical & Pharmaceutical University, Toyama, Japan
Arata Murakami
Affiliation:
Department of Pediatrics and the First Division of Surgery, Toyama Medical & Pharmaceutical University, Toyama, Japan
Toshio Miyawaki
Affiliation:
Department of Pediatrics and the First Division of Surgery, Toyama Medical & Pharmaceutical University, Toyama, Japan
*
Fukiko Ichida, MD, Department of Pediatrics, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama, Toyama 930-01, Japan. Tel. 81-764-34-2281; Fax. 81-764-34-5029
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Abstract

To evaluate the potential efficacy of the combined administration of inhaled nitric oxide and oral beraprost sodium in producing pulmonary vasodilation, we studied 20 patients with pulmonary hypertension during cardiac catheterization. We also evaluated some of the mechanisms of vasodilation under these circumstances by investigating the levels of cyclic GMP and AMP in the pulmonary venous blood. A significant decrease in pulmonary vascular resistance was observed after the administration of nitric oxide (−37 ± 6%, p<0.01), and more intense decrease was observed after the combined administration of nitric oxide and beraprost sodium (−46 ± 6%, p<0.05). In addition, the ratio of pulmonary-to-systemic resistance also decreased to a greater extent with combined administration than with nitric oxide alone (−34 ± 6% vs −42 ± 7%, p<0.05). Conversely, systemic vascular resistance showed no change, neither after loading with nitric oxide nor after combined administration. Although equivalent increases in levels of cyclic GMP were observed after inhalation of nitric and the combined administration (mean 78% vs 65%), greater increases in levels of cyclic AMP were observed with the combined use (mean 15% vs 69%). Combined treatment with nitric oxide and beraprost sodium may prove markedly beneficial in patients with primary and postoperative pulmonary hypertension who do not respond adequately to inhalation of nitric oxide alone or conventional modes of treatment.

Keywords

Oral prostacyclin analoguenitric oxidecyclic GMPcyclic AMPpulmonary hypertension
Type
Young Investigators Award
Information
Cardiology in the Young , Volume 7 , Issue 4 , October 1997 , pp. 362 - 369
Copyright
Copyright © Cambridge University Press 1997

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