[Hemodynamic effects of enoximone in patients with low left ventricular ejection fraction in surgery for ischemic heart disease].
Acute heart failure following cardiac surgery in extracorporeal circulation (EC) still poses a formidable problem requiring intensive pharmacological therapy and, often, also mechanical support. Preoperatively reduced left ventricular (LV) function raises the risk for the development of this complication. In their pilot study, the authors evaluated the haemodynamic effects of enoximone, a selective phosphodiesterase III inhibitor, administered at a dose of 1 mg/kg b.w. to 15 patients with a preoperative LV ejection fraction < or = 35% 15 minutes before weaning from EC after an elective myocardial revascularization procedure. All patients were weaned from EC at first attempt without any problems and left the operating theatre in good condition. Enoximone administration led, in the monitored period (45 minutes after administration), to statistically significant increases in cardiac index (+68%; p < 0.01), oxygen supply (+75%; p < 0.01) and oxygen saturation in mixed venous blood (+10%; p < 0.1) and statistically significant decreases in pulmonary and systemic vascular resistance indexes (-52% and -48%, respectively; p < 0.001) and in oxygen extraction (-31%; p < 0.001). These changes were associated with decreases in central venous, mean pulmonary artery, and pulmonary capillary wedge pressure (n.s.). No serious side effects were seen, and the authors conclude enoximone can be the drug of first choice in high-risk patients following heart surgery in EC and requiring inotropic support.
Kakác
J
J
Klinika kardiologie, Klinika anesteziologie a resuscitace, Institut klinické a experimentální medicíny, Praha, Ceská republika.
Brezina
A
A
Pirk
J
J
D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery*; D017335:Enoximone / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects*
D017335:Enoximone
Hemodynamické úcinky enoximonu u nemocných s nízkou ejekcní frakcí levé komory srdecní operovaných pro ischemickou chorobu srdecní.