Nitric oxide-associated pulmonary edema in children with pulmonary venous hypertension

Pediatr Cardiol. 2013 Apr;34(4):817-25. doi: 10.1007/s00246-012-0538-7. Epub 2012 Oct 13.

Abstract

Nitric oxide (NO)-associated pulmonary edema is rarely reported in children; in adults, it is often associated with left-sided heart failure. We report a case series of children with NO-associated pulmonary edema, which was defined as new multilobar alveolar infiltrates and worsening hypoxemia within 24 h of initiation or escalation of NO and radiologic or clinical improvement after NO discontinuation. We identified six patients (0.4-4 years old) with ten episodes of NO-associated pulmonary edema. Diagnoses included atrioventricular canal defect with mitral valve disease (n = 2), pulmonary atresia and major aorta-pulmonary collateral arteries (n = 2), total anomalous pulmonary venous return (n = 1), and pulmonary veno-occlusive disease (n = 1). All patients had evidence of pulmonary venous hypertension, and two had mitral valve disease resulting in clinical evidence of left-sided heart failure. Pulmonary edema improved or resolved within 24 h of discontinuing NO. At cardiac catheterization, mean left atrial pressure was <15 mmHg in three of three patients (none with mitral valve disease), whereas pulmonary artery occlusion pressure was >15 mmHg in two of five patients. In conclusion, we describe six young children with NO-associated pulmonary edema and pulmonary venous hypertension. Only two of these children had left-sided heart failure: Left atrial pressure as well as pulmonary artery occlusion pressure may not be helpful in identifying children at risk for NO-associated pulmonary edema.

Publication types

  • Case Reports

MeSH terms

  • Cardiac Catheterization
  • Child, Preschool
  • DiGeorge Syndrome / therapy
  • Down Syndrome / therapy
  • Endothelium-Dependent Relaxing Factors / adverse effects*
  • Female
  • Heart Defects, Congenital / drug therapy*
  • Humans
  • Hypertension, Pulmonary / drug therapy*
  • Infant
  • Male
  • Nitric Oxide / adverse effects*
  • Pulmonary Edema / chemically induced*
  • Pulmonary Veins / abnormalities
  • Pulmonary Veno-Occlusive Disease / therapy

Substances

  • Endothelium-Dependent Relaxing Factors
  • Nitric Oxide