[Enoximone and the therapeutic strategy in patients awaiting emergency cardiac graft].
Enoximone is a positive inotropic agent belonging to the group of phosphodiesterase F-III inhibitors. The drug was tested in 34 patients uncontrolled by sympathomimetic drugs and referred to our department for urgent heart transplantation or circulatory assistance. After insertion of a Swan-Ganzgatheter and a radial artery catheter for haemodynamic monitoring, enoximone was administered as a 15-minute intravenous bolus injection of 1 to 2.5 mg/kf every 8 hours, in addition to sympathomimetic agents. Clinical and haemodynamic improvement was observed after thirty minutes in 30 patients. The cardiac index rose from 1.82 to 2.67 l/min/m2 and the pulmonary wedge pressure fell from 30.8 to 18.9 mmHg. Systemic arterial resistance decreased from 2170 to 1520 dyn. s. cm-5, and pulmonary resistance from 5.5 to 4.6 Wood units (p less than 0.01 for all values). Four patients had no haemodynamic improvement and were put on circulatory assistance, using a Jarvik 7 total artificial heart in 3 of them and heterotopic circulatory assistance in one. After clinical investigation for contra-indication to heart transplantation, and as their improved haemodynamic status permitted, 12 of the 30 patients were considered suitable (group B) for heart transplantation. Transplantation was performed within a week of admission in 11 patients without any need for mechanical assistance. One of the group B patients who required implantation of a Jarvik 7 artificial heart died after 12 hours of assistance. Eighteen patients were considered unsuitable for transplantation (group A) and treated medically.(ABSTRACT TRUNCATED AT 250 WORDS)
Dubois-Randé
J L
JL
CHU Henri-Mondor, Créteil.
Loisance
D
D
Duval-Moulin
A M
AM
Deleuze
P
P
Lellouche
D
D
Tavolaro
O
O
Hittinger
L
L
Benvenuti
C
C
Merlet
P
P
Brun
D
D
D000328:Adult; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004630:Emergencies; D017335:Enoximone; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged
D002316:Cardiotonic Agents; D007093:Imidazoles; D017335:Enoximone
Enoximone et stratégie thérapeutique chez des patients en attente d'une greffe cardiaque en urgence.