Hypercontractile heart failure caused by catecholamine therapy in premature neonates.
Catecholamine treatment for hypotension is common practice in neonatal intensive care units. In the presence of left ventricular hypertrophy, the positive inotropic action of catecholamines with mainly beta-receptor specificity can lead to excessive hypercontractility and paradoxical hypotension. This reports presents two cases of hypercontractile heart failure during beta-agonist treatment in very low birthweight (VLBW) infants. Both patients (27 wk, 5 d; and 26 wk, 6 d of gestation) underwent surgical arterial duct ligation and coarctation repair. After operation they developed arterial hypotension that failed to respond to epinephrine (adrenaline) or dobutamine treatment. Echocardiography demonstrated a complete systolic obliteration of the left ventricular cavity. Epinephrine and dobutamine were stopped, and norepinephrine (noradrenaline) was successfully used to control the hypotension.


CONCLUSIONS
Treatment of hypotension with beta-agonists in VLBW infants with left ventricular hypertrophy can lead to hypercontractility and left ventricular obliteration with paradoxical hypotension. Careful echocardiographic monitoring is indicated in such cases.
Germanakis
I
I
Department of Congenital Heart Disease, Albert-Ludwigs-University Hospital, Freiburg, Germany.
Bender
C
C
Hentschel
R
R
Braun
K
K
Dittrich
S
S
Kececioglu
D
D
D000322:Adrenergic Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D004280:Dobutamine / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000139:chemically induced* / Q000188:drug therapy*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology*; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects*; D009638:Norepinephrine / Q000009:adverse effects* / Q000627:therapeutic use; D014463:Ultrasonography
D000322:Adrenergic Agonists; D000318:Adrenergic beta-Agonists; D004280:Dobutamine; D009638:Norepinephrine; D004837:Epinephrine