Effect of milrinone on postbypass pulmonary hypertension in children after tetralogy of Fallot repair.
BACKGROUND
Postbypass pulmonary hypertension in surgical correction of tetralogy of Fallot (TOF) is a risk for right ventricular failure. Effective management remains a major challenge. Milrinone is a new drug with a unique mechanism of "inodilation", which offers both inotropic and vasodilatory effects. We attempted to determine if application of milrinone could improve cardiopulmonary dysfunction in children after TOF repair.


METHODS
We studied 10 children with postbypass pulmonary hypertension after TOF repair within six months. Heart rate, systolic pulmonary arterial pressure (PAP), systolic arterial blood pressure (SBP), pulmonary capillary wedge pressure and PAP/SBP ratio were recorded. Standard cardiopulmonary bypass (CPB) was performed. After CPB, if PAP/SBP was more than 0.5, pulmonary hypertension was suspected and milrinone was administered with a loading dose of 20 micrograms/kg followed by continuous infusion of 0.2 microgram/kg/minute. Hemodynamics were compared before and after administration of milrinone to evaluate its effect.


RESULTS
significant reduction in PAP/SBP ratio within 15 minutes was found after administration of milrinone. The effect persisted for 24 hours during continuous infusion of milrinone. No remarkable adverse effect was noted in the study.


CONCLUSIONS
We conclude that milrinone is effective in the management of pulmonary hypertension following CPB in children who underwent TOF repair.
Chu
C C
CC
Department of Anesthesiology, Taipei Veterans General Hospital, Taiwan, ROC.
Lin
S M
SM
New
S H
SH
Ting
C K
CK
Chow
L H
LH
Tsou
M Y
MY
Tsai
S K
SK
Lee
T Y
TY
D000293:Adolescent; D000328:Adult; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D007223:Infant; D008297:Male; D020105:Milrinone / Q000627:therapeutic use*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy*; D013771:Tetralogy of Fallot / Q000601:surgery*
D010726:Phosphodiesterase Inhibitors; D020105:Milrinone