Recurrence of pulmonary hypertension after ventricular septal defect closure and perioperative response to nitric oxide

The ability of inhaled nitric oxide to reduce pulmonary vascular resistance is currently used to select borderline patients for reparative surgery and to treat postoperative crises of pulmonary hypertension. A case of an infant with non-restrictive VSD who classified as a nitric oxide responder both in the catheterization laboratory and after surgery, but developed recurrent pulmonary hypertension is described. The limitations of inhaled nitric oxide in predicting the natural history of successfully operated patients are discussed.