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Early experience with Levosimendan in children with ventricular dysfunction
Poongundran Namachivayam1, David S Crossland, Warwick W Butt
1Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.
Insights
Levosimendan, a calcium-sensitizing agent, safely treated critically ill infants and children with severe heart failure. It reduced catecholamine use and improved myocardial performance, especially in acute heart failure cases.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Pharmacology
Background:
- Severe heart failure in pediatric patients presents significant challenges, often requiring inotropic support.
- Current treatments may have limitations, necessitating novel therapeutic agents.
Purpose of the Study:
- To evaluate the preliminary safety and efficacy of Levosimendan, a novel calcium-sensitizing agent, in critically unwell infants and children with severe heart failure.
- To assess the impact of Levosimendan on hemodynamic parameters, catecholamine requirements, and myocardial function.
Main Methods:
- Retrospective cohort analysis of 15 pediatric patients (7 days to 18 years) with severe heart failure requiring inotropic support.
- Administration of Levosimendan as a single dose (bolus and infusion) under continuous hemodynamic monitoring.
- Echocardiographic assessment of ventricular function before and after Levosimendan treatment.
Main Results:
- Levosimendan administration did not significantly alter heart rate, systolic pressure, diastolic pressure, mean blood pressure, or central venous pressure.
- Catecholamine infusions were discontinued in 10 patients and reduced in 3 others.
- Overall ejection fraction improved from 29.8% to 40.5% (p = .015), with a significant increase in patients with acute heart failure.
Conclusions:
- Levosimendan is safe for use in infants and children experiencing severe heart failure.
- The drug effectively reduced the need for catecholamine infusions in both end-stage and acute heart failure.
- Levosimendan demonstrated an objective improvement in myocardial performance, particularly in pediatric patients with acute heart failure.
Objective:
To describe our preliminary experience with Levosimendan, a new calcium-sensitizing agent in critically unwell infants and children with severe heart failure.
Design:
Retrospective cohort analysis.
Setting:
Pediatric intensive care unit.
Patients:
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).
Interventions:
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.
Measurements And Main 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.
