Effects of milrinone for right ventricular failure after left ventricular assist device implantation.
Right ventricular failure after left ventricular assist device implantation sometimes requires additional mechanical right ventricular support. The effectiveness of nitrates, prostaglandin, or nitric oxide inhalation in such cases has already been reported. However, there are few reports on the administration of phosphodiesterase inhibitor for right ventricular failure after left ventricular assist device implantation. We report two patients with right ventricular failure after left ventricular assist device implantation successfully treated with milrinone. Both had residual pulmonary hypertension due to high pulmonary vascular resistance after left ventricular assist device implantation. However, intravenous milrinone caused a significant reduction in pulmonary vascular resistance and an increase in left ventricular assist device flow. Milrinone acts as both an inotropic agent and a direct vasodilator, and thus may avoid the need for mechanical support for right ventricular failure due to residual pulmonary hypertension after left ventricular assist device implantation.
Kihara
Shin'ichiro
S
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University. kiharas@msx.upmc.edu
Kawai
Akihiko
A
Fukuda
Takuya
T
Yamamoto
Noboru
N
Aomi
Shigeyuki
S
Nishida
Hiroshi
H
Endo
Masahiro
M
Koyanagi
Hitoshi
H
D000293:Adolescent; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use*; D010138:Pacemaker, Artificial; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy* / Q000503:physiopathology
D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors; D014665:Vasodilator Agents; D020105:Milrinone