Comparison of Inhaled Nitric Oxide and Inhaled Aerosolized Prostacyclin in the Evaluation of Heart Transplant Candidates With Elevated Pulmonary Vascular Resistance
Study objective: Elevated pulmonary vascular resistance is a risk factor in heart transplantation and reversibility of high pulmonary vascular resistance is evaluated preoperatively in potential recipients using IV vasodilators or inhaled nitric oxide. Prostacyclin is a potent vasodilator, which whe...
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| Veröffentlicht in: | Chest 1998-09, Vol.114 (3), p.780-786 |
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| creator | Haraldsson, Åsa Kieler-Jensen, Niels Nathorst-Westfelt, Ulla Bergh, Claes-Håkan Ricksten, Sven-Erik |
| description | Study objective: Elevated pulmonary vascular resistance is a risk factor in heart transplantation and reversibility of high pulmonary vascular resistance is evaluated preoperatively in potential recipients using IV vasodilators or inhaled nitric oxide. Prostacyclin is a potent vasodilator, which when inhaled, has selective pulmonary vasodilatory properties. The aim of this study was to compare the central hemodynamic effects of inhaled prostacyclin with those of inhaled nitric oxide in heart transplant candidates.
Design: A pharmacodynamic comparative study.
Setting: Cardiothoracic ICU or laboratory for diagnostic heart catheterization at a university hospital.
Patients: Ten heart transplant candidates with elevated pulmonary vascular resistance (>200 dynes o s o cm−5 and/or a transpulmonary pressure gradient > 10 mm Hg) were included in the study.
Interventions: Nitric oxide (40 ppm) and aerosolized prostacyclin (10 μg/mL) were administered by inhalation in two subsequent 10-min periods. Hemodynamic measurements preceeded and followed inhalation of each agent.
Measurements and results: Both inhaled nitric oxide and inhaled prostacyclin reduced mean pulmonary artery pressure (–7% vs −7%), pulmonary vascular resistance (–43% vs −49%), and the transpulmonary gradient (–44% vs −38%). With inhaled prostacyclin, an 11% increase in cardiac output was observed. Other hemodynamic variables, including the systemic BP, remained unaffected by each of the agents.
Conclusions: Inhaled prostacyclin induces a selective pulmonary vasodilation that is comparable to the effect of inhaled nitric oxide. Major advantages with inhaled prostacyclin are its lack of toxic reactions and easy administration as compared with the potentially toxic nitric oxide requiring more complicated delivery systems.
(CHEST 1998; 114:780–786)
Abbreviations: CO=cardiac output; CVP=central venous pressure; HR=heart rate; LV=left ventricle; MAP=mean arterial BP; MPAP=mean pulmonary artery pressure; NO=nitric oxide; NO2=nitrogen dioxide; PCWP=pulmonary capillary wedge pressure; PGI2=prostacyclin; PVR=pulmonary vascular resistance; SaO2= arterial oxygen saturation; SV=stroke volume; SvO2=mixed venous oxygen saturation; SVR = systemic vascular resistance; TPG=transpulmonary pressure gradient |
| doi_str_mv | 10.1378/chest.114.3.780 |
| format | Article |
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Design: A pharmacodynamic comparative study.
Setting: Cardiothoracic ICU or laboratory for diagnostic heart catheterization at a university hospital.
Patients: Ten heart transplant candidates with elevated pulmonary vascular resistance (>200 dynes o s o cm−5 and/or a transpulmonary pressure gradient > 10 mm Hg) were included in the study.
Interventions: Nitric oxide (40 ppm) and aerosolized prostacyclin (10 μg/mL) were administered by inhalation in two subsequent 10-min periods. Hemodynamic measurements preceeded and followed inhalation of each agent.
Measurements and results: Both inhaled nitric oxide and inhaled prostacyclin reduced mean pulmonary artery pressure (–7% vs −7%), pulmonary vascular resistance (–43% vs −49%), and the transpulmonary gradient (–44% vs −38%). With inhaled prostacyclin, an 11% increase in cardiac output was observed. Other hemodynamic variables, including the systemic BP, remained unaffected by each of the agents.
Conclusions: Inhaled prostacyclin induces a selective pulmonary vasodilation that is comparable to the effect of inhaled nitric oxide. Major advantages with inhaled prostacyclin are its lack of toxic reactions and easy administration as compared with the potentially toxic nitric oxide requiring more complicated delivery systems.
(CHEST 1998; 114:780–786)
Abbreviations: CO=cardiac output; CVP=central venous pressure; HR=heart rate; LV=left ventricle; MAP=mean arterial BP; MPAP=mean pulmonary artery pressure; NO=nitric oxide; NO2=nitrogen dioxide; PCWP=pulmonary capillary wedge pressure; PGI2=prostacyclin; PVR=pulmonary vascular resistance; SaO2= arterial oxygen saturation; SV=stroke volume; SvO2=mixed venous oxygen saturation; SVR = systemic vascular resistance; TPG=transpulmonary pressure gradient</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.114.3.780</identifier><identifier>PMID: 9743166</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: Elsevier Inc</publisher><subject>Administration, Inhalation ; Adult ; aerosolized prostacyclin ; Aerosols ; Biological and medical sciences ; Cardiac catheterization ; Catheters ; Epoprostenol - administration & dosage ; Epoprostenol - pharmacology ; Female ; Heart rate ; Heart Transplantation ; Heart transplants ; Hemodynamics ; Hemodynamics - drug effects ; Humans ; Hypertension, Pulmonary - diagnosis ; Hypertension, Pulmonary - drug therapy ; inhalation ; Intubation ; Laboratories ; Male ; Medical sciences ; Middle Aged ; Nitric oxide ; Nitric Oxide - administration & dosage ; Nitric Oxide - pharmacology ; Nitrogen dioxide ; Oxygen saturation ; Patient Selection ; Patients ; Preoperative Care ; Pulmonary arteries ; Pulmonary Artery - drug effects ; Pulmonary Artery - physiopathology ; Pulmonary Circulation ; Pulmonary hypertension ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Vascular Resistance - drug effects ; Vasodilation - drug effects ; Vasodilator Agents - administration & dosage ; Vasodilator Agents - pharmacology ; Veins & arteries</subject><ispartof>Chest, 1998-09, Vol.114 (3), p.780-786</ispartof><rights>1998 The American College of Chest Physicians</rights><rights>1998 INIST-CNRS</rights><rights>Copyright American College of Chest Physicians Sep 1998</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-19bc23c9afaede401e4552d71c4731bbb041e8bd8d02d936dcd49d2e0f2f43fb3</citedby><cites>FETCH-LOGICAL-c438t-19bc23c9afaede401e4552d71c4731bbb041e8bd8d02d936dcd49d2e0f2f43fb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2390001$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9743166$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Haraldsson, Åsa</creatorcontrib><creatorcontrib>Kieler-Jensen, Niels</creatorcontrib><creatorcontrib>Nathorst-Westfelt, Ulla</creatorcontrib><creatorcontrib>Bergh, Claes-Håkan</creatorcontrib><creatorcontrib>Ricksten, Sven-Erik</creatorcontrib><title>Comparison of Inhaled Nitric Oxide and Inhaled Aerosolized Prostacyclin in the Evaluation of Heart Transplant Candidates With Elevated Pulmonary Vascular Resistance</title><title>Chest</title><addtitle>Chest</addtitle><description>Study objective: Elevated pulmonary vascular resistance is a risk factor in heart transplantation and reversibility of high pulmonary vascular resistance is evaluated preoperatively in potential recipients using IV vasodilators or inhaled nitric oxide. Prostacyclin is a potent vasodilator, which when inhaled, has selective pulmonary vasodilatory properties. The aim of this study was to compare the central hemodynamic effects of inhaled prostacyclin with those of inhaled nitric oxide in heart transplant candidates.
Design: A pharmacodynamic comparative study.
Setting: Cardiothoracic ICU or laboratory for diagnostic heart catheterization at a university hospital.
Patients: Ten heart transplant candidates with elevated pulmonary vascular resistance (>200 dynes o s o cm−5 and/or a transpulmonary pressure gradient > 10 mm Hg) were included in the study.
Interventions: Nitric oxide (40 ppm) and aerosolized prostacyclin (10 μg/mL) were administered by inhalation in two subsequent 10-min periods. Hemodynamic measurements preceeded and followed inhalation of each agent.
Measurements and results: Both inhaled nitric oxide and inhaled prostacyclin reduced mean pulmonary artery pressure (–7% vs −7%), pulmonary vascular resistance (–43% vs −49%), and the transpulmonary gradient (–44% vs −38%). With inhaled prostacyclin, an 11% increase in cardiac output was observed. Other hemodynamic variables, including the systemic BP, remained unaffected by each of the agents.
Conclusions: Inhaled prostacyclin induces a selective pulmonary vasodilation that is comparable to the effect of inhaled nitric oxide. Major advantages with inhaled prostacyclin are its lack of toxic reactions and easy administration as compared with the potentially toxic nitric oxide requiring more complicated delivery systems.
(CHEST 1998; 114:780–786)
Abbreviations: CO=cardiac output; CVP=central venous pressure; HR=heart rate; LV=left ventricle; MAP=mean arterial BP; MPAP=mean pulmonary artery pressure; NO=nitric oxide; NO2=nitrogen dioxide; PCWP=pulmonary capillary wedge pressure; PGI2=prostacyclin; PVR=pulmonary vascular resistance; SaO2= arterial oxygen saturation; SV=stroke volume; SvO2=mixed venous oxygen saturation; SVR = systemic vascular resistance; TPG=transpulmonary pressure gradient</description><subject>Administration, Inhalation</subject><subject>Adult</subject><subject>aerosolized prostacyclin</subject><subject>Aerosols</subject><subject>Biological and medical sciences</subject><subject>Cardiac catheterization</subject><subject>Catheters</subject><subject>Epoprostenol - administration & dosage</subject><subject>Epoprostenol - pharmacology</subject><subject>Female</subject><subject>Heart rate</subject><subject>Heart Transplantation</subject><subject>Heart transplants</subject><subject>Hemodynamics</subject><subject>Hemodynamics - drug effects</subject><subject>Humans</subject><subject>Hypertension, Pulmonary - diagnosis</subject><subject>Hypertension, Pulmonary - drug therapy</subject><subject>inhalation</subject><subject>Intubation</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nitric oxide</subject><subject>Nitric Oxide - administration & dosage</subject><subject>Nitric Oxide - pharmacology</subject><subject>Nitrogen dioxide</subject><subject>Oxygen saturation</subject><subject>Patient Selection</subject><subject>Patients</subject><subject>Preoperative Care</subject><subject>Pulmonary arteries</subject><subject>Pulmonary Artery - drug effects</subject><subject>Pulmonary Artery - physiopathology</subject><subject>Pulmonary Circulation</subject><subject>Pulmonary hypertension</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Vascular Resistance - drug effects</subject><subject>Vasodilation - drug effects</subject><subject>Vasodilator Agents - administration & dosage</subject><subject>Vasodilator Agents - pharmacology</subject><subject>Veins & arteries</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1UU1v1DAQjRCobAtnTkgW4pqtvzYfx2q10EoVRajA0XLsCXHlJIvtLJTf0x_KlEQLFyRLntHMvDfzXpa9YnTNRFmdmw5iWjMm12JdVvRJtmK1YLnYSPE0W1HKeC6Kmj_PTmO8o5izujjJTupSClYUq-xhO_Z7HVwcBzK25GrotAdLPrgUnCE3P50Fogd7LFxAGOPo3S-MP2KYtLk33g0EX-qA7A7aTzq5Ge4SdEjkNugh7r0eEtkilrM6QSRfXerIzsMBM8SafD8OOtyTLzqayetAPkF0iD8YeJE9a7WP8HL5z7LP73a328v8-ub91fbiOjdSVClndWO4MLVuNViQlIHcbLgtmZGlYE3TUMmgamxlKbe1KKyxsrYcaMtbKdpGnGVvZtx9GL9PKKy6G6cwIKXilEq6EVxg0_ncZPD8GKBV--B63Fwxqh49UX88UeiJEgo9wYnXC-zU9GCP_YsJWH-71PF07VuUy7h4bOOifjTuL3HnvnU_XAAVe-09goqZcln2X-J6ngAU7eAgqGgcoKAWp01SdnT_Xfo38YK9fA</recordid><startdate>19980901</startdate><enddate>19980901</enddate><creator>Haraldsson, Åsa</creator><creator>Kieler-Jensen, Niels</creator><creator>Nathorst-Westfelt, Ulla</creator><creator>Bergh, Claes-Håkan</creator><creator>Ricksten, Sven-Erik</creator><general>Elsevier Inc</general><general>American College of Chest Physicians</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>19980901</creationdate><title>Comparison of Inhaled Nitric Oxide and Inhaled Aerosolized Prostacyclin in the Evaluation of Heart Transplant Candidates With Elevated Pulmonary Vascular Resistance</title><author>Haraldsson, Åsa ; Kieler-Jensen, Niels ; Nathorst-Westfelt, Ulla ; Bergh, Claes-Håkan ; Ricksten, Sven-Erik</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-19bc23c9afaede401e4552d71c4731bbb041e8bd8d02d936dcd49d2e0f2f43fb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Administration, Inhalation</topic><topic>Adult</topic><topic>aerosolized prostacyclin</topic><topic>Aerosols</topic><topic>Biological and medical sciences</topic><topic>Cardiac catheterization</topic><topic>Catheters</topic><topic>Epoprostenol - administration & dosage</topic><topic>Epoprostenol - pharmacology</topic><topic>Female</topic><topic>Heart rate</topic><topic>Heart Transplantation</topic><topic>Heart transplants</topic><topic>Hemodynamics</topic><topic>Hemodynamics - drug effects</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - diagnosis</topic><topic>Hypertension, Pulmonary - drug therapy</topic><topic>inhalation</topic><topic>Intubation</topic><topic>Laboratories</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nitric oxide</topic><topic>Nitric Oxide - administration & dosage</topic><topic>Nitric Oxide - pharmacology</topic><topic>Nitrogen dioxide</topic><topic>Oxygen saturation</topic><topic>Patient Selection</topic><topic>Patients</topic><topic>Preoperative Care</topic><topic>Pulmonary arteries</topic><topic>Pulmonary Artery - drug effects</topic><topic>Pulmonary Artery - physiopathology</topic><topic>Pulmonary Circulation</topic><topic>Pulmonary hypertension</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Vascular Resistance - drug effects</topic><topic>Vasodilation - drug effects</topic><topic>Vasodilator Agents - administration & dosage</topic><topic>Vasodilator Agents - pharmacology</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Haraldsson, Åsa</creatorcontrib><creatorcontrib>Kieler-Jensen, Niels</creatorcontrib><creatorcontrib>Nathorst-Westfelt, Ulla</creatorcontrib><creatorcontrib>Bergh, Claes-Håkan</creatorcontrib><creatorcontrib>Ricksten, Sven-Erik</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Haraldsson, Åsa</au><au>Kieler-Jensen, Niels</au><au>Nathorst-Westfelt, Ulla</au><au>Bergh, Claes-Håkan</au><au>Ricksten, Sven-Erik</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Inhaled Nitric Oxide and Inhaled Aerosolized Prostacyclin in the Evaluation of Heart Transplant Candidates With Elevated Pulmonary Vascular Resistance</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>1998-09-01</date><risdate>1998</risdate><volume>114</volume><issue>3</issue><spage>780</spage><epage>786</epage><pages>780-786</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>Study objective: Elevated pulmonary vascular resistance is a risk factor in heart transplantation and reversibility of high pulmonary vascular resistance is evaluated preoperatively in potential recipients using IV vasodilators or inhaled nitric oxide. Prostacyclin is a potent vasodilator, which when inhaled, has selective pulmonary vasodilatory properties. The aim of this study was to compare the central hemodynamic effects of inhaled prostacyclin with those of inhaled nitric oxide in heart transplant candidates.
Design: A pharmacodynamic comparative study.
Setting: Cardiothoracic ICU or laboratory for diagnostic heart catheterization at a university hospital.
Patients: Ten heart transplant candidates with elevated pulmonary vascular resistance (>200 dynes o s o cm−5 and/or a transpulmonary pressure gradient > 10 mm Hg) were included in the study.
Interventions: Nitric oxide (40 ppm) and aerosolized prostacyclin (10 μg/mL) were administered by inhalation in two subsequent 10-min periods. Hemodynamic measurements preceeded and followed inhalation of each agent.
Measurements and results: Both inhaled nitric oxide and inhaled prostacyclin reduced mean pulmonary artery pressure (–7% vs −7%), pulmonary vascular resistance (–43% vs −49%), and the transpulmonary gradient (–44% vs −38%). With inhaled prostacyclin, an 11% increase in cardiac output was observed. Other hemodynamic variables, including the systemic BP, remained unaffected by each of the agents.
Conclusions: Inhaled prostacyclin induces a selective pulmonary vasodilation that is comparable to the effect of inhaled nitric oxide. Major advantages with inhaled prostacyclin are its lack of toxic reactions and easy administration as compared with the potentially toxic nitric oxide requiring more complicated delivery systems.
(CHEST 1998; 114:780–786)
Abbreviations: CO=cardiac output; CVP=central venous pressure; HR=heart rate; LV=left ventricle; MAP=mean arterial BP; MPAP=mean pulmonary artery pressure; NO=nitric oxide; NO2=nitrogen dioxide; PCWP=pulmonary capillary wedge pressure; PGI2=prostacyclin; PVR=pulmonary vascular resistance; SaO2= arterial oxygen saturation; SV=stroke volume; SvO2=mixed venous oxygen saturation; SVR = systemic vascular resistance; TPG=transpulmonary pressure gradient</abstract><cop>Northbrook, IL</cop><pub>Elsevier Inc</pub><pmid>9743166</pmid><doi>10.1378/chest.114.3.780</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Chest, 1998-09, Vol.114 (3), p.780-786 |
| issn | 0012-3692 1931-3543 |
| language | eng |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Administration, Inhalation Adult aerosolized prostacyclin Aerosols Biological and medical sciences Cardiac catheterization Catheters Epoprostenol - administration & dosage Epoprostenol - pharmacology Female Heart rate Heart Transplantation Heart transplants Hemodynamics Hemodynamics - drug effects Humans Hypertension, Pulmonary - diagnosis Hypertension, Pulmonary - drug therapy inhalation Intubation Laboratories Male Medical sciences Middle Aged Nitric oxide Nitric Oxide - administration & dosage Nitric Oxide - pharmacology Nitrogen dioxide Oxygen saturation Patient Selection Patients Preoperative Care Pulmonary arteries Pulmonary Artery - drug effects Pulmonary Artery - physiopathology Pulmonary Circulation Pulmonary hypertension Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Vascular Resistance - drug effects Vasodilation - drug effects Vasodilator Agents - administration & dosage Vasodilator Agents - pharmacology Veins & arteries |
| title | Comparison of Inhaled Nitric Oxide and Inhaled Aerosolized Prostacyclin in the Evaluation of Heart Transplant Candidates With Elevated Pulmonary Vascular Resistance |
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