[Vasodilatator testing with nitric oxide (bronchial control treatment system--BCTS) in patients with pulmonary...

Nitric oxide (NO) is one of the most important mediators produced in the human organism. It participates in the regulation of blood vessel lumens, activation of leucocytes and platelet; it is a mediator in the nervous system and in inflammation reactions. It was proved that in cases of patients with pulmonary hypertension, a decreased secretion of nitric oxide and an increased synthesis of endothelin-1 is observed. Therefore, in case of patients with pulmonary hypertension the exogenous, inhaled nitric oxide (iNO) is applied. It is added to the respiratory mixture and it passes through the alveolar-capillary barrier to the smooth muscle cells where it activates a guanyle cyclase, similarly to the physiologically produced nitric oxide. It was proved that it decreases pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP). Inhaled nitric oxide is applied for treatment purposes to patients after cardiosurgical operations, mainly heart transplantation and correction of valvular defects with accompanying pulmonary hypertension, as well as after implantation of the left ventricular assist device in order to relieve the right chamber. In case of patients qualified for cardiosurgical operations with the accompanying pulmonary hypertension as well as in case of patients with the arterial pulmonary hypertension a diagnostical test using iNO is carried out in order to determine further course of therapeutical treatment. The application of the new method of iNO administration by the BCTS (Bronchial Control Treatment System) method allows for a precise administration of accurately determined doses of iNO and its full utilisation through addition to the respiratory mixture in the initial phase of inspiration. The risk of side effects is also decreased; so far no influence on the circulatory system or an increase of the level of methemoglobin was observed.