[Hemodynamic effects of an alpha-blocking vasodilator in cardiac insufficiency caused by left-right shunt in children]
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Nicergoline, an alpha-blocking vasodilator, effectively reduced pulmonary and systemic blood pressure in infants with severe cardiac failure. While it decreased the left-to-right shunt in most patients, responses varied, indicating a need for further research.
Area of Science:
- Cardiology
- Pharmacology
- Pediatrics
Context:
- Severe cardiac failure in infants often results from large left-to-right interventricular shunts.
- Hemodynamic assessment during cardiac catheterization is crucial for managing such conditions.
Purpose:
- To evaluate the acute hemodynamic effects of nicergoline in infants with severe cardiac failure due to large left-to-right interventricular shunts.
- To determine nicergoline's impact on systemic and pulmonary pressures, cardiac output, and shunt volume.
Summary:
- Nicergoline administration (0.05-0.2 mg/kg/min IV) significantly lowered mean systemic (16%) and pulmonary arterial (13%) pressures in 10 infants.
- Pulmonary and systemic flow ratio (Qp/Qs) decreased by 21% in 8 patients, indicating shunt reduction, but increased by over 50% in 2 patients.
- Pulmonary to systemic resistance ratio (Rp/Rs) increased in patients with shunt reduction and decreased in those with shunt increase, with no clear predictors for response variability.
Impact:
- Nicergoline demonstrates potential in managing hemodynamics in infants with severe cardiac failure and interventricular shunts.
- The variable response in shunt volume highlights the complexity of nicergoline's effects and the need for individualized treatment strategies.
- Further investigation is warranted to understand the mechanisms behind nicergoline's differential effects on left-to-right shunts.
Abstract:
The acute haemodynamic effects of an alpha-blocking vasodilator, nicergoline, observed during cardiac catheterisation were studied in 9 babies and 1 infant (mean age 11 months) with severe cardiac failure due to a large left-to-right interventricular shunt. Nicergoline was administered intravenously at a dose of 0.05 mg/kg/mn to 0.2 mg/kg/mn to lower mean systemic blood pressure by at least 10 mmHg. No significant changes in heart rate or in right and left atrial pressures were observed. On the other hand, mean systemic and pulmonary arterial pressures fell by 16% (p less than 0.001) and 13% (p less than 0.01) respectively. The ratio of pulmonary and systemic flow (Qp/Qs) decreased in 8 patients by an average of 21% (p less than 0.002). This fall was accompanied by a parallel reduction in oxygen concentrations of pulmonary arterial blood (16%) compared with mixed venous blood. However, the Qp/Qs ratio increased in the other 2 patients by over 50%. In the group of 8 patients in which the left-to-right shunt decreased, the ratio of pulmonary to systemic resistance (Rp/Rs) increased by 33% (p less than 0.002) whilst this value fell by 36% in the 2 patients in whom the volume of the shunt increased. There were no discriminatory parameters between the two groups with regards to age, pulmonary artery pressures, the volume of the shunt (Qp/Qs) or level of pulmonary resistances (Rp/Rs) to explain the variability of the therapeutic response on the left-to-right shunt.(ABSTRACT TRUNCATED AT 250 WORDS)