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Use of levosimendan, a new inodilator, for postoperative myocardial stunning in a premature neonate

Lechner, Evelyn MD; Moosbauer, Werner MD; Pinter, Miklos MD; Mair, Rudolf MD; Tulzer, Gerald MD, PD

Pediatric Critical Care Medicine: January 2007 - Volume 8 - Issue 1 - p 61-63
doi: 10.1097/01.PCC.0000253026.67341.5D
Case Reports

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.

Design: Single case report.

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

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

Interventions: The patient underwent arterial switch operation.

Measurements and Main 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 μg·kg−1·min−1, increased to 0.1 μg·kg−1·min−1, 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.

From the Department of Pediatric Cardiology (EL, MP, GT), Intensive Care Unit (WM), and Congenital Heart Surgery (RM), Children's Heart Center Linz, Linz, Austria; and the Intensive Care Unit, General Hospital Linz (WM), Linz, Austria.

The authors have not disclosed any potential conflicts of interest.

©2007The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies