Nebulized Sodium Nitroprusside In Treatment Of Congenital Heart Disease With Pulmonary Arterial Hypertension

Objective :To evaluate the effect of nebulized sodium nitroprusside(neb-SNP) on hemodynamics in children with pulmonary arterial hypertension (PAH) secondary to congenital heart disease(CHD) .To study whether nebulized sodium nitroprusside can selectively lower pulmonary artery pressure and explore a convenient and safer way for the treatment of PAH secondary to CHD.Methods :22 patients (16 boys and 6 girls) in hospital with PAH secondary to CHD were enrolled in this research, aged between 45 days to3.6 years, weighted between 3.8 to 13kg. PAH was diagnosed by echocardiograph (ECHO) displaying pulmonary artery systolic pressure (PASP)>30mmHg, PAMP>20mmHg, combining with clinic symptom, X-Ray displaying pulmonary congestion, cardio-thoracic ratio 0.56-0.76 and ECG. All patients did not use any drugs of decreasing PAP,MAP. Inhalation was drived by the air compressor pump to inhale SNP(5mg/ml) 2ml ,15-20 minutes .HR,SaO2 and MAP were monitored continuously. Before and 5,10,20 minutes after inhalation treatment and 10 minutes after stopping inhalation, ECHO was used to measure the tricuspid valve pressure speed,pulmonary valve pressure speed,MAP,LVEF,SaO2,HR,right ventricular preejection period(RPEP)/accelerate time(AT),and Lb (the left ventricular eject time LVET),La. PAMP,PASP were calculated. Results :1.The PAMP,PASP started to decrease obviously from 38.09±4.16 mmHg,48.91±6.33 mmHg to 34.09±5.28 mmHg,43.95±5.59 mmHg respectively in 5 minutes after inhalation of SNP treatment (P <0.05),and continued decreasing in 10,20 minutes after inhalation (P <0.01), the data regained the original value 10 minutes after stopping inhalation(P >0.05). 2.The Tei index decreased significantly from 0.48±0.05 to 0.40±0.04 and LVEF increased from 58.14±7.43% to 65.36±6.55 %after inhalation of SNP treatment(P <0.05). ; The SaO2 increased obviously from 83.23±6.35% to 89.82±5.14% after inhalation of SNP treatment (P <0.05). 4 the MAP,HR were rarely changed in all time (P >0.05). 4. All the data regained the original value 10 minutes after stopping inhalation (P >0.05). Conclusion:1. The neb-SNP is an effective selective pulmonary vasodilator for the treatment of pulmonary hypertension, and is no affection to SAP.2. The neb-SNP can improve the cardiac function and oxygenation.3. The neb-SNP is possible to treat PAH besides INO. Compared with INO, It may be the more convenient and safer way for the treatment of PAH secondary to CHD.