title: Oral Enoximone as an Alternative to Protracted Intravenous Medication in Severe Pediatric Myocardial Failure.
abstract: Phosphodiesterase 3 inhibitors have been used successfully in pediatric patients with acute or chronic myocardial dysfunction over the last two decades. Their protracted continuous intravenous administration is associated with risk of infectious and thromboembolic complications. Weaning intravenous medication and starting oral angiotensin-converting enzyme (ACE) inhibitors and/or beta-blockers can be challenging. We reviewed retrospectively hospital records of 48 patients receiving oral enoximone treatment in a single tertiary pediatric cardiac center between November 2005 and April 2014. Failure to wean from intravenous milrinone infusion and/or intolerance of ACE inhibitors and/or beta-blockers was indications for oral enoximone treatment. Age of the patients ranged between 0.5 and 191 months (median 7.5 months) at the time of starting enoximone treatment. There were 14 patients (29 %) with left ventricular dysfunction due to myocarditis or dilated cardiomyopathy and 34 patients (71 %) with myocardial dysfunction complicating congenital heart disease. Fifteen (44 %) of these 34 patients had left ventricular dysfunction, 13 (38 %) right ventricular dysfunction, and in 6 (18 %) both ventricles were failing. Duration of oral enoximone treatment was between 3 days and 34 months (median of 2.3 months). Myocardial functional recovery allowed for weaning of enoximone treatment in 15 patients (31 %) after 6 days-15 months (median 5 months). No adverse hemodynamic effects were noted. Blood stained gastric aspirates encountered in two patients resolved with concomitant milk administration. Based on our limited experience, oral enoximone is a well-tolerated and promising alternative to intravenous medication and/or other commonly used oral medications in selected pediatric patients with chronic heart failure.
authors.affiliation: Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK.
authors.forename: Anke K
authors.initials: AK
authors.lastname: Furck
authors.affiliation: Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK.
authors.forename: Siân
authors.initials: S
authors.lastname: Bentley
authors.affiliation: Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK.
authors.forename: Margarita
authors.initials: M
authors.lastname: Bartsota
authors.affiliation: Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Rigby
authors.affiliation: Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK. Zdenek.Slavik@rbht.nhs.uk.
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Slavik
mesh_terms: D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D002648:Child; D017335:Enoximone; D006333:Heart Failure; D006439:Hemodynamics; D006801:Humans; D020105:Milrinone; D018487:Ventricular Dysfunction, Left
chemical_list: D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D017335:Enoximone; D020105:Milrinone
keywords: Congenital heart disease; Heart failure; Pediatric; Phosphodiesterase inhibitor