HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Glen Van Arsdell Ian Adatia Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Humpl, T. Articles by Adatia, I. Search for Related Content PubMed PubMed Citation Articles by Humpl, T. Articles by Adatia, I. Related Collections Congenital - acyanotic

J Thorac Cardiovasc Surg 2002;124:806-810
© 2002 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Levels of exhaled nitric oxide before and after surgical and transcatheter device closure of atrial septal defects in children

From the Divisions of Cardiology^a and Cardiovascular Surgery^b and the Departments of Pediatrics,^c Anesthesia,^d Critical Care Medicine,^e Surgery,^f Respiratory Medicine,^g and Population Health Sciences,^h Toronto Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.

Received for publication June 11, 2001. Revisions requested Aug 6, 2001; revisions received Oct 17, 2001. Accepted for publication Oct 22, 2001. Address for reprints: Ian Adatia, MB, ChB, Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada (E-mail: ian.adatia{at}sickkids.ca).

Objectives: We have shown that exhaled nitric oxide levels decrease after surgical closure of congenital left-to-right cardiac shunts. It remains unclear whether the change in exhaled nitric oxide levels reflects endothelial injury caused by the use of cardiopulmonary bypass or the decrease in pulmonary blood flow attendant on shunt closure. Transcatheter atrial septal defect closure permits shunt closure without the use of cardiopulmonary bypass. Therefore we compared changes in exhaled nitric oxide levels after surgical and transcatheter device closure of atrial septal defects.
Methods: We enrolled sequentially 30 children undergoing atrial septal defect closure. Fifteen patients (age range, 0.4-16 years; median age, 6.5 years) underwent surgical atrial septal defect closure with cardiopulmonary bypass, and 15 patients (age range, 4-17 years; median age, 8.4 years) had device closure of the atrial septal defect in the catheterization laboratory. We measured nitric oxide levels in end-tidal expiratory gas with a rapid-response chemiluminescent analyzer before and after atrial septal defect closure.
Results: After surgical repair of the atrial septal defect, exhaled nitric oxide decreased by 21%, from 10.9 ± 4.4 to 8.4 ± 3.3 ppb (P < .005), whereas after transcatheter defect closure, exhaled nitric oxide increased by 23%, from 7.6 ± 2.6 to 9.3 ± 3.7 ppb (P < .005). Hemoglobin levels in patients undergoing surgical intervention were significantly lower (P = .0001) postoperatively.
Conclusions: We confirmed that exhaled nitric oxide, despite a fall in hemoglobin, decreases after surgical closure of atrial septal defects. In contrast, exhaled nitric oxide levels increase after transcatheter closure. Exhaled nitric oxide levels may reflect bypass-induced endothelial cell injury and are independent of changes in pulmonary blood flow.

This article has been cited by other articles:

				G Santoro, M Pascotto, S Caputo, F Cerrato, M Cappelli Bigazzi, M T Palladino, C Iacono, M Carrozza, M G Russo, and R Calabro Similar cardiac remodelling after transcatheter atrial septal defect closure in children and young adults Heart, July 1, 2006; 92(7): 958 - 962. [Abstract] [Full Text] [PDF]

				ATS Workshop Proceedings: Exhaled Nitric Oxide and Nitric Oxide Oxidative Metabolism in Exhaled Breath Condensate. Proceedings of the ATS, January 1, 2006; 3(2): 131 - 145. [Full Text] [PDF]

				C. Alexiou, A. T.M. Tang, D. C. Smith, S. V. Sheppard, M. P. Haw, and R. Gibbs Reply Ann. Thorac. Surg., November 1, 2005; 80(5): 1977 - 1978. [Full Text] [PDF]

				ATS/ERS Recommendations for Standardized Procedures for the Online and Offline Measurement of Exhaled Lower Respiratory Nitric Oxide and Nasal Nitric Oxide, 2005 Am. J. Respir. Crit. Care Med., April 15, 2005; 171(8): 912 - 930. [Full Text] [PDF]

				C. Alexiou, A. T.M. Tang, S. V. Sheppard, M. P. Haw, R. Gibbs, and D. C. Smith A Prospective Randomized Study to Evaluate the Effect of Leukodepletion on the Rate of Alveolar Production of Exhaled Nitric Oxide During Cardiopulmonary Bypass Ann. Thorac. Surg., December 1, 2004; 78(6): 2139 - 2145. [Abstract] [Full Text] [PDF]

				N. Marczin Exhaled nitric oxide and cardiac surgery with extracorporeal circulation J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1673 - 1674. [Full Text] [PDF]

				I. Adatia, T. Humpl, and P. E. Silkoff Reply to the editor J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1674 - 1675. [Full Text] [PDF]