Pilot Study of Inhaled Nitric Oxide to Treat Pulmonary Insufficiency in Congenital Heart Disease

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00543933
Recruitment Status : Terminated (Investigator left institution)
First Posted : October 15, 2007
Last Update Posted : January 27, 2017
Information provided by (Responsible Party):
The Cleveland Clinic

Brief Summary:
Inhaled nitric oxide in patients with pulmonic valve insufficiency.

Condition or disease Intervention/treatment Phase
Pulmonary Insufficiency Drug: iNO administered Early Phase 1

Detailed Description:
Pulmonic valve insufficiency (PI) is a well-defined problem after primary surgical repair of Tetralogy of Fallot (TOF). Though well-tolerated for years, long-term PI can lead to structural changes in the right ventricle, the sequelae of which include right heart failure, arrhythmia, and sudden cardiac death. The only current treatment for severe symptomatic PI is pulmonic valve replacement. We hypothesize that inhaled nitric oxide (iNO), a selective pulmonary vasodilator, can acutely decrease PI as assessed by cardiac magnetic resonance imaging (CMR). Methods: 22 consecutive patients with PI in the setting of corrected TOF or post pulmonic valve balloon valvuloplasty will undergo a clinically indicated CMR. Nitric oxide gas will be delivered via facemask through a specialized delivery device at 40ppm. After 5 minutes, flow velocity mapping and gradient echo sequences will be repeated to assess pulmonary regurgitant fraction, right ventricular volumes, and ejection fraction. Nitric oxide will be discontinued after acquisition of the last picture. Wilcoxon rank-sum for paired data will be used to assess effect of intervention. Significance: If decreasing pulmonary vascular resistance decreases PI, medical therapy with long-acting pulmonary vasodilators may be an attractive therapeutic option with the goal of delaying or even obviating pulmonic valve replacement.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 18 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Acute Effect of Inhaled Nitric Oxide on Pulmonary Insufficiency in Congenital Heart Disease
Actual Study Start Date : October 2007
Actual Primary Completion Date : June 2010
Actual Study Completion Date : June 2010

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Heart Diseases

Arm Intervention/treatment
Experimental: iNO administered
iNO administered at 40 ppm via a non-rebreather mask
Drug: iNO administered
iNO at 40 ppm through a non-rebreather mask for 5 minutes
Other Name: Nitric Oxide

Primary Outcome Measures :
  1. pulmonary regurgitant volume and fraction [ Time Frame: Single time point ]
    Aortic regurgitant fraction measured by CMR velocity flow mapping

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Known pulmonary insufficiency status
  • Previous Tetralogy of Fallot repair or balloon valvuloplasty/surgical valvotomy for pulmonary stenosis
  • Clinically indicated cardiac magnetic resonance imaging study

Exclusion Criteria:

  • Enrollment in another clinical trial
  • Age less then 18 years
  • Inability to provide informed consent
  • Institutionalized individual
  • Pregnant or lactating
  • Serious claustrophobia
  • Pacemaker/ICD
  • Aneurysm clips
  • Internal hardware
  • Severe obesity (>350lbs)
  • Residual ventricular septal defect
  • History of methemoglobinemia
  • History of blood dyscrasias
  • Acute pulmonary infection
  • Pulmonary edema
  • Hypersensitivity to nitric oxide or any of its components
  • Left ventricle dysfunction (EF<40%)
  • Concurrent use of nitroglycerin or prilocaine

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00543933

United States, Ohio
The Cleveland Clinic
Cleveland, Ohio, United States, 44195
Sponsors and Collaborators
The Cleveland Clinic
Principal Investigator: Richard Krasuski, MD The Cleveland Clinic

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: The Cleveland Clinic Identifier: NCT00543933     History of Changes
Other Study ID Numbers: 07-491
First Posted: October 15, 2007    Key Record Dates
Last Update Posted: January 27, 2017
Last Verified: January 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes

Additional relevant MeSH terms:
Heart Diseases
Heart Defects, Congenital
Cardiovascular Diseases
Cardiovascular Abnormalities
Congenital Abnormalities
Nitric Oxide
Bronchodilator Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Asthmatic Agents
Respiratory System Agents
Free Radical Scavengers
Molecular Mechanisms of Pharmacological Action
Neurotransmitter Agents
Endothelium-Dependent Relaxing Factors
Vasodilator Agents
Protective Agents