Use of levosimendan, a new inodilator, for postoperative myocardial stunning in a premature neonate.
OBJECTIVE
To first report the successful use of the new inodilator levosimendan in a premature infant with congestive heart failure (CHF) following cardiac surgery. Although the calcium sensitizer levosimendan improves hemodynamics in adults with CHF, no data are available on the use of levosimendan in premature infants with CHF.


METHODS
Single case report.


METHODS
Twenty-bed postoperative adult and pediatric cardiac intensive care unit.


METHODS
A 32 wks gestational age, 1525-g premature male twin with transposition of the great arteries.


METHODS
The patient underwent arterial switch operation.


RESULTS
Immediately after operation, the patient developed signs of low cardiac output syndrome. Mixed venous saturation was 56%, serum lactate increased to 14.8 mmol/L, systolic arterial pressure was 40 mm Hg, left atrial pressure was 24 mm Hg, and echocardiography showed reduced left ventricular function with a fractional shortening of 10%. There were no signs of reduced coronary perfusion. Milrinone, dobutamine, and epinephrine did not improve hemodynamics. Levosimendan was initiated at a dose of 0.05 mug.kg.min, increased to 0.1 mug.kg.min, and continuously infused for 24 hrs. Within 6 hrs after starting the levosimendan infusion, left atrial pressure decreased to 7 mm Hg and systolic arterial pressure increased to 60 mm Hg; within 24 hrs after initiation serum lactate level normalized to 1.7 mmol/L and mixed venous saturation increased to 81%. Echocardiography revealed improvement of left ventricular function with a fractional shortening of 25%. No side effects were recognized during administration of levosimendan.


CONCLUSIONS
In this premature neonate with postoperative low cardiac output syndrome due to failing myocardial function, levosimendan was a potent inotropic agent.
Lechner
Evelyn
E
Department of Pediatric Cardiology, Children's Heart Center Linz, Linz, Austria.
Moosbauer
Werner
W
Pinter
Miklos
M
Mair
Rudolf
R
Tulzer
Gerald
G
D002303:Cardiac Output, Low / Q000209:etiology; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004452:Echocardiography; D005500:Follow-Up Studies; D005865:Gestational Age; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D015278:Intensive Care Units, Pediatric; D008297:Male; D017682:Myocardial Stunning / Q000188:drug therapy*; D011183:Postoperative Complications / Q000188:drug therapy*; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use*; D000077464:Simendan; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000601:surgery*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging; D016277:Ventricular Function, Left
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan