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Re: Pediatric Pulmonary Hypertension and Prolonged Inhaled Nitric Oxide Therapy

We read with interest the report of McMahon and colleagues (Heart 2001;86:e1) regarding a case of rapid regression of primary pulmonary hypertension in a 14 month old child. Although the authors describe this as spontaneous regression, the patient underwent two months of continuous nitric oxide therapy prior to resolution of her disease. This case may in fact be similar to our previously reported series of four infants with severe primary pulmonary hypertension who were treated with prolonged inhaled nitric oxide and heparin therapy (1). Three out of four patients had long term reduction in pulmonary artery pressures that have been sustained in up to 62 months of follow up. The demonstrated ability of inhaled nitric oxide to decrease vascular smooth muscle proliferation, reduce hypoxic lung vessel remodeling and inhibit platelet aggregation may be useful in long-term therapy of primary pulmonary hypertension in children and warrants further prospective study.