Systemic effects of intracoronary nitroglycerin during coronary angiography: In children after heart transplantation

Diego A. Lara, Mary K. Olive, James F. George, Robert N. Brown, Waldemar F. Carlo, Edward V. Colvin, Brad L. Steenwyck, F. Bennett Pearce

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Coronary spasm during coronary angiography for vasculopathy in children can be prevented by the intracoronary administration of nitroglycerin. We reviewed the anesthesia and catheterization reports and charts for pediatric transplant recipients who underwent angiography from 2005 through 2010. Correlation analysis was used to study the relation of post-injection systolic blood pressure (SBP) to nitroglycerin dose. Forty-one angiographic evaluations were performed on 25 patients (13 male and 12 female). Mean age was 9.9 ± 3.2 years (range, 3.3-16.1 yr). The mean total dose of nitroglycerin was 2.93 ± 1.60 μg/ kg (range, 1-8 μg/kg). There was a significant drop between the baseline SBP (mean, 106 ± 21.6 mmHg) and the lowest mean SBP before nitroglycerin administration (78 ± 13.2, P <0.0001, paired t test). There was no significant additional change in SBP (mean after nitroglycerin administration, 80.7 ± 13.1 mmHg; P=0.2). There was a significant drop in lowest heart rate between baseline (109 ± 16.5 beats/min) and before nitroglycerin administration (89 ± 14.3 beats/min; P <0.0001, paired t test). There was no significant additional change in heart rate (mean heart rate after nitroglycerin, 84 ± 17.7 beats/min; P=0.09). There were 2 interventions for SBP before nitroglycerin and 2 after nitroglycerin. One child experienced a transient ST-T-segment change during angiography after nitroglycerin. In the highest dose range, the additional decrease in SBP was 7.2 mmHg (P=0.03). Routine intracoronary nitroglycerin administration in this dose range produced no significant changes in SBP or heart rate in children.

Original languageEnglish
Pages (from-to)21-25
Number of pages5
JournalTexas Heart Institute Journal
Volume41
Issue number1
DOIs
StatePublished - Feb 2014
Externally publishedYes

Keywords

  • Child
  • Coronary angiography
  • Coronary vasospasm/etiology
  • Doseresponse relationship
  • Drug
  • Heart transplantation/ adverse effects
  • Hemodynamics/ drug effects
  • Nitroglycerin/administration and dosage/therapeutic use
  • Postoperative complications
  • Retrospective studies
  • Therapy
  • Vasodilation/drug effects

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