[Treatment of acute low cardiac output syndrome after surgery of congenital heart defects: value of enoximone].
Children undergoing cardiac surgery are at additional risk for postoperative low cardiac output syndrome (LCOS). Anticipation of the syndrome from preoperative hemodynamic condition, surgical procedure, and adverse intraoperative events is a key to successful postoperative management. Inotropic support is primarily based on catecholamines. However, uncoupling of human cardiac beta-adrenoceptors during cardiopulmonary bypass with cardioplegic cardiac arrest may be the reason why many patients respond only weakly to beta-adrenoceptor agonists. Phosphodiesterase (PDE) inhibitors act by reducing intracellular breakdown of cAMP, which is elevated independently from beta-receptors. The use of PDE-inhibitors might be advantageous in patients with uncoupled beta-adrenoceptors, as occurs after cardiopulmonary bypass. In addition, PDE-inhibitors can prevent further downregulation of the adrenoceptors due to avoiding prolonged therapy by beta-agonists. In this context, the addition of enoximone, a PDE-inhibitor, to adrenergic agents has been found useful in increasing cardiac output in children with catecholamine-resistant LCO, as well as in children with compensated hemodynamics during catecholamine therapy.
Schranz
D
D
Universitätskinderklinik Mainz.
Bauer
J
J
Wiemann
J
J
Kühl
G
G
Dapper
F
F
Wippermann
C F
CF
Huth
R
R
Oelert
H
H
D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D017335:Enoximone / Q000008:administration & dosage* / Q000009:adverse effects; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects / Q000502:physiology; D005996:Nitroglycerin / Q000008:administration & dosage / Q000009:adverse effects
D017335:Enoximone; D005996:Nitroglycerin; D004837:Epinephrine
Behandlung des akuten Low-cardiac-output-Syndroms nach Operationen angeborener Herzfehler: Stellenwert von Enoximon.