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Moore, Wayne; McCulloch, Michael; Cies, Jeffrey; Davis, Deborah

doi: 10.1097/01.ccm.0000425403.71196.7d
Poster: ABSTRACT Only

Case Reports: Levosimendan, a calcium sensitizer and inodilator, improves lusitropy and inotropy with minimal chronotropic effects. Despite these benefits, levosimendan has not been used extensively in the treatment of pediatric heart failure. Heart failure, defined as the inability to provide enough systemic oxygen delivery to meet the body’s metabolic needs, has been correlated with brain natriuretic peptide (BNP) levels. We describe our experience with levosimendan in an infant with decompensated heart failure using BNP levels as a surrogate for disease severity. A newborn diagnosed with pulmonary atresia, nearly intact ventricular septum, severe right ventricular hypoplasia, and diffuse coronary artery sinusoids underwent placement of a 5mm balloon expandable stent within the ductus arteriosus whose flow was then restricted using a 4mm band. The patient developed severe systolic and diastolic heart failure as manifested by large volume pleural effusions, renal failure, and anasarca and was listed for heart transplantation. After clinical improvements were not seen on dopamine and milrinone infusions, a levosimendan infusion was initiated at 0.1 mcg/kg/min and titrated to 0.2 mcg/kg/min for a 48 hour duration. Her baseline BNP level was 1530 pg/mL prior to the initiation of levosimendan therapy and decreased to 160 pg/mL following the initial infusion. Subsequent levosimendan infusions were administered weekly for a total of 6 courses, each of 48 hours duration, ultimately producing a BNP nadir of 32 pg/mL. Levosimendan is widely used in Europe for the treatment of acutely decompensated severe chronic heart failure. We believe this is one of the first reported cases trending BNP levels following multiple levosimendan infusions in an infant with heart failure. Although the patient ultimately expired from multiorgan failure, the decreased BNP levels suggested significantly improved heart function, particularly diastolic function. Further studies are warranted to evaluate the safety of multiple courses of levosimendan in pediatric patients with severe heart failure and its impact on heart function and clinical outcomes.

Alfred I. duPont Hospital for Children

St. Christopher’s Hospital For Children

Alfred I. duPont Hospital for Children

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins