Early experience with Levosimendan in children with ventricular dysfunction.
OBJECTIVE
To describe our preliminary experience with Levosimendan, a new calcium-sensitizing agent in critically unwell infants and children with severe heart failure.


METHODS
Retrospective cohort analysis.


METHODS
Pediatric intensive care unit.


METHODS
Fifteen children aged 7 days to 18 yrs (median age 38 months) with severe myocardial dysfunction secondary to end-stage heart failure, or acute heart failure, who were inotrope-dependent (requiring at least one catecholamine).


METHODS
A single dose (bolus and intravenous infusion over 24-48 hrs) of Levosimendan was given under continuous hemodynamic monitoring in our intensive care unit. Eleven children received a single dose, three children received two doses, and one child received four doses. Echocardiographic assessments of ventricular function were made before and 3-5 days after Levosimendan infusion.


RESULTS
Heart rate, systolic pressure, diastolic pressure, mean blood pressure, and central venous pressure were unchanged during and after Levosimendan. Levosimendan allowed for discontinuation of catecholamines in ten patients and a dose reduction in three. The dose of dobutamine was reduced from 6.4 microg/kg/min pre-Levosimendan to 1.8 microg/kg/min on day 5 (p < .01). Ejection fraction for the group as a whole improved from 29.8% to 40.5% (p = .015); this did not increase significantly in patients with end-stage heart failure but increased by 63% in the children with acute heart failure.


CONCLUSIONS
Levosimendan can be safely administered to infants and children with severe heart failure. Levosimendan allowed for substantial reduction in catecholamine infusions in children with end-stage or acute heart failure and also produced an objective improvement in myocardial performance in children with acute heart failure.
Namachivayam
Poongundran
P
Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.
Crossland
David S
DS
Butt
Warwick W
WW
Shekerdemian
Lara S
LS
D000293:Adolescent; D002303:Cardiac Output, Low / Q000188:drug therapy*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002395:Catecholamines / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016638:Critical Illness; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D011724:Pyridazines / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077464:Simendan; D013318:Stroke Volume / Q000187:drug effects; D014463:Ultrasonography; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging / Q000188:drug therapy*
D002316:Cardiotonic Agents; D002395:Catecholamines; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan