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Denopamine augments the left ventricular pump function in infants with ventricular septal defect and pulmonary
1Department of Pediatrics, School of Medicine, Sapporo Medical University, Japan.
Insights
Oral denopamine shows promise in infants with left-to-right shunt disease, improving cardiac function and systemic output. Careful dosing is advised to prevent excessive heart rate and pulmonary blood flow increases.
Area of Science:
- Pediatric Cardiology
- Pharmacology
Background:
- Left-to-right shunt diseases in infants can lead to significant hemodynamic compromise.
- Pulmonary hypertension is a common complication in infants with ventricular septal defects.
Purpose of the Study:
- To evaluate the hemodynamic effects and clinical benefits of oral denopamine in infants with left-to-right shunt disease.
- To assess the relationship between denopamine serum concentrations and hemodynamic changes.
Main Methods:
- Doppler echocardiography was used to measure cardiac parameters in 17 infants with ventricular septal defect and pulmonary hypertension.
- Infants were divided into two groups receiving different doses of denopamine (1 mg/kg or 0.5 mg/kg).
- Serum denopamine concentrations were measured using high-performance liquid chromatography.
Main Results:
- Oral denopamine significantly increased heart rates, left ventricular shortening fractions, and decreased left ventricular end-systolic dimensions.
- Peak and mean velocities of aortic and pulmonary flows increased, but the pulmonary to aortic flow velocity ratio remained unchanged.
- Hemodynamic changes showed an exponential correlation with serum denopamine concentrations.
Conclusions:
- Denopamine may enhance systemic output by improving left ventricular pump function in infants with ventricular septal defects.
- Caution is recommended to avoid excessive increases in heart rate and pulmonary blood flow with denopamine treatment.
Abstract:
The purpose of this study is to evaluate hemodynamic effects and clinical benefit of oral denopamine in infants with left to right shunt disease. We measured heart rates, left ventricular end-diastolic and end-systolic dimensions, shortening fractions, peak and mean flow velocities of the main pulmonary artery and ascending aorta at 30, 60 and 90 min after oral denopamine using Doppler echocardiography. Seventeen infants with ventricular septal defect and pulmonary hypertension (mean pulmonary artery pressures higher than 25 mmHg) were divided into two groups depending upon the doses of denopamine; group 1 received 1 mg/kg, and group 2 was given 0.5 mg/kg. Serum concentrations of denopamine were measured with high performance liquid chromatography after completion of these evaluations. In both groups, heart rates and left ventricular shortening fractions increased, and left ventricular end-systolic dimensions decreased significantly. Although peak and mean velocities of aortic and pulmonary flows increased significantly, there were no significant alterations in peak and mean velocity ratios of pulmonary to aortic flow. There was no significant difference in the serum concentration of denopamine between the two groups. However, percentage changes of some indices, such as heart rates, left ventricular end-systolic dimensions, peak aortic and pulmonary flow velocities, and mean aortic flow velocities exponentially correlated to serum concentrations of denopamine. In conclusion, denopamine is supposed to have beneficial actions to augment the systemic output by enhancing the left ventricular pump function in patients of ventricular septal defect. However, we should be careful for denopamine not to produce excessive increases in heart rate and pulmonary blood flow.