OBJECTIVE: This study reviews our experience with the use of nitric oxide inhalation (NOi) in the treatment of the refractory pulmonary hypertensive crisis (PHC) during the immediate post-operative period (IPOP) of heart transplantation (HT). METHOD: Between Oct/97 and Feb/02, 31 HT in adults were performed. Among them were patients with Pulmonary Vascular Resistance (PVR) greater than 6 uW, or patients with PVR greater than 2,5 uW during the pharmacological test. All patients were weaned from the CPB (M=101±21 minutes) in use of dobutamine, dopamine and milrinone. In the absence of an adequate response to these drugs and with the evidence of PHC, NOi was given, beginning with 20ppm and increasing, when necessary, up to 40ppm. The recording of the left atrium and pulmonary artery pressures, serial arterial blood gases samples and trans-thoracic echocardiograms (TTE) were performed. The donor's brain death (BD) time mean was 16±5,1 hours. RESULTS: In five patients (1 female) (mean age = 42 years) NOi was employed, due to low cardiac output signs and evidence of PHC and right ventricular dysfunction. The mean CPB time was 150,8±34,3 min. The pre-NOi mean PAP was 87 mmHg (range 75-115), and the mean arterial PO2 = 60mmHg (FiO2=100%). The TTE showed moderate-severe dilation of the right ventricle. NOi was given during a mean of 35h (range 6 to 96), being weaned only after hemodynamic stability was achieved. There was only one early death, at the 17th post op. day due to sepsis. All the remaining patients are in NYHA class I. CONCLUSIONS: The prolonged CPB time (> 120 min) and the time of brain death of the donor are factors that increase the risk of PHC. The NOi is a useful tool in dealing with this complication when there is an inadequate response to the conventional treatment.
Nitric oxide; Heart transplantation; Right ventricular dysfunction; Pulmonary hypertension
