Milrinone and low cardiac output following cardiac surgery in infants: is there a direct myocardial effect?
We assessed the effect of milrinone on myocardial function in pediatric patients with postoperative low cardiac output syndrome by index of myocardial performance in a prospective, open-label, nonrandomized, consecutive study. Fifteen patients with low cardiac output syndrome following cardiac surgical treatment were studied in the tertiary cardiothoracic pediatric intensive care unit between April 2001 and November 2003 (age range, 0.2-16 months; median, 7; weight, 2.7-11.8 kg; median, 5). Echocardiographic, Doppler-derived, time interval-based index of myocardial performance (Tei index) was used to study cardiac function prior to and while on intravenous milrinone treatment for 18-24 hours. Treatment with milrinone led to improvement in biventricular myocardial function [mean right ventricular index from 0.521 (SD-0.213) to 0.385 (SD-0.215), p = 0.003; mean left ventricular index from 0.636 (SD-0.209) to 0.5 (SD-0.171), p = 0.012). No difference was found in the values of heart rate corrected right or left ventricular ejection time prior to and while on treatment with milrinone (right ventricle: mean, 1.23 (SD-0.42) and 1.14 (SD-0.48), p = 0.29; left ventricles: mean, 1.17 (SD-0.51) and 1.13 (SD-0.48), p = 0.66) Our data support the direct myocardial effect of milrinone as part of the mechanism behind its already proven benefit in children with low cardiac output syndrome following cardiac surgery.
Duggal
B
B
Paediatric Intensive Care Unit, Royal Brompton & Harefield NHS Trust, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
Pratap
U
U
Slavik
Z
Z
Kaplanova
J
J
Macrae
D
D
D002303:Cardiac Output, Low / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015150:Echocardiography, Doppler; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D020105:Milrinone / Q000008:administration & dosage / Q000627:therapeutic use*; D009200:Myocardial Contraction / Q000187:drug effects*; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D020105:Milrinone