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J Am Coll Cardiol, 2000; 35:463-467 © 2000 by the American College of Cardiology Foundation |
a Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
Manuscript received June 2, 1999; revised manuscript received September 21, 1999, accepted October 27, 1999.
Reprint requests and correspondence: Dr. Jeffrey R. Fineman, University of California, San Francisco, 505 Parnassus Avenue, Box 0106, M-680, San Francisco, California 94143-0106
jfineman{at}pedcard.ucsf.edu
OBJECTIVE
To determine the effect of pulmonary blood flow (Qp) on nitric oxide (NO) production in patients with increased Qp due to an atrial septal defect (ASD).
BACKGROUND
Alterations in pulmonary vascular NO production have been implicated in the development of pulmonary hypertension secondary to increased Qp. In vitro, acute changes in flow or shear stress alter NO production. However, the effect of Qp on lung NO production in vivo is unclear.
METHODS
Nineteen patients (2.461 years of age, median 17) with secundum ASD undergoing device closure were studied. Before, and 30 min after ASD closure, exhaled NO and plasma nitrate concentration were measured by chemiluminescence (NOA 280, Sievers, Boulder, Colorado).
RESULTS
Before ASD closure, all patients had increased Qp (Qp: systemic blood flow [Qs] of 2.0 ± 0.7) and normal mean pulmonary arterial pressure (13.4 ± 3.1 mm Hg). Atrial septal defect device closure decreased Qp from 6.0 ± 2.5 to 3.6 ± 1.3 L/min/m2 (p < 0.05). Mean pulmonary arterial pressure was unchanged. Associated with the decrease in Qp, both exhaled NO (22.1%, p < 0.05) and plasma nitrate concentrations (17.9%, p < 0.05) decreased.
CONCLUSIONS
These data represent the first demonstration that acute changes in Qp alter pulmonary NO production in vivo in humans. Exhaled NO determinations may provide a noninvasive assessment of pulmonary vascular NO production in patients with congenital heart disease. Potential correlations between exhaled NO, pulmonary vascular reactivity and pulmonary hypertension warrant further study.
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