ACA App
Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
Home | About us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Submission | Subscribe | Advertise | Contact | Login 
Users online: 715 Small font size Default font size Increase font size Print this article Email this article Bookmark this page
 


 

 
     
    Advanced search
 

 
 
     
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed2304    
    Printed85    
    Emailed2    
    PDF Downloaded244    
    Comments [Add]    

Recommend this journal

 


 
 
LETTER TO EDITOR  
Year : 2011  |  Volume : 14  |  Issue : 1  |  Page : 66-67
Inhaled nitroglycerin in the treatment of pulmonary hypertension


Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India

Click here for correspondence address and email

Date of Web Publication31-Dec-2010
 

How to cite this article:
Parida S, Badhe AS. Inhaled nitroglycerin in the treatment of pulmonary hypertension. Ann Card Anaesth 2011;14:66-7

How to cite this URL:
Parida S, Badhe AS. Inhaled nitroglycerin in the treatment of pulmonary hypertension. Ann Card Anaesth [serial online] 2011 [cited 2019 Jul 22];14:66-7. Available from: http://www.annals.in/text.asp?2011/14/1/66/74410


The Editor,

I read with interest the article by Dr. Mandal et al. titled "Acute hemodynamic effects of inhaled nitroglycerine, intravenous nitroglycerin, and their combination with intravenous dobutamine in patients with secondary pulmonary hypertension". [1] I congratulate the authors on their well-conceived study. They provide a cheap, convenient and safe alternative to inhaled nitric oxide (NO), which has been widely acclaimed as the most effective and selective pulmonary vasodilator. However, few aspects of the study require further clarification.

The study was apparently designed to be conducted in patients undergoing elective mitral valve replacement or double valve replacement surgery in patients with valvular heart diseases associated pulmonary arterial hypertension (PAH), defined as mean pulmonary artery pressures (mPAPs) >25 mmHg. Patients with post bypass mPAP <25 mmHg were to be excluded from participating in the study.

Yet, a perusal of the hemodynamic parameters table reveals that the median baseline mPAP, prior to intervention, was <25 mmHg in all the groups which were studied, except in the inhaled nitroglycerin (NTG) group in which the mPAP was 25.5 mmHg. Similarly, the lower limits of the ranges mentioned for all of the groups are well below the 25 mmHg mPAP cut-off mentioned in the exclusion criteria. Thus, it appears that a substantial chunk of the patients studied might have had their mPAPs below the 25 mmHg mark, mentioned as a pre-requisite for enrolling such patients for the study. In such a case, it would not be appropriate to extrapolate the inferences gleaned from this study to patients who have moderate to severe elevations of mPAP in the immediate post bypass period. The authors' contention that inhaled NTG might be more beneficial than IV NTG in patients with right ventricular dysfunction secondary to PAH is again an attractive conjecture that however needs to be investigated in that group of patients.

 
   References Top

1.Mandal B, Kapoor PM, Chowdhury U, Kiran U, Choudhury M. Acute hemodynamic effects of inhaled nitroglycerine, intravenous nitroglycerine, and their combination with intravenous dobutamine in patients with secondary pulmonary hypertension. Ann Card Anaesth 2010;13:138-44.  Back to cited text no. 1
[PUBMED]  Medknow Journal  

Top
Correspondence Address:
Satyen Parida
Qr. No. E-44, JIPMER Campus, Dhanvantari Nagar, Pondicherry - 605 006
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.74410

Rights and Permissions




 

Top
Previous articleNext article