Inhaled nitric oxide in the neonate with cardiac disease.

As a selective pulmonary vasodilator, inhaled nitric oxide is an important diagnostic and therapeutic agent for the treatment of pulmonary hypertension in patients with congenital heart disease. Among 400 patients treated in our center with nitric oxide, 37% were newborns. Hemodynamic benefit was shown in newborns with total anomalous pulmonary venous connection, in those with congenital mitral stenosis, and in postoperative patients with preexisting left to right shunts and other lesions. It can be used to help discriminate anatomic obstruction to pulmonary blood flow from pulmonary vasoconstriction, and it may be used in the treatment or prevention of pulmonary hypertensive crises after cardiopulmonary bypass. However, none of the purported benefits of inhaled nitric oxide in children with congenital heart disease have been studied in a randomized, placebo-controlled manner.