Levosimendan in Severe Right Ventricular Failure Following Mitral Valve Replacement

Do calcium sensitizers affect right ventricular functions in patients with chronic heart failure?

“…Some authorities have implied that levosimendan produces pulmonary, systemic, and coronary vasodilatation through the opening of the adenosine triphosphate sensitive potassium channels on the sarcolemma of vascular smooth muscle cells [5,9]. In a case report, levosimendan decreased pulmonary artery systolic pressure and resistance in patients with severe RV failure with minimal metabolic cost [10]. Related to these arguments is the critique that RV failure progresses quickly from compensated to end-stage because of a vicious cycle of auto-aggravation compared with LV physio-pathology.…”

Levosimendan: The current situation and new prospects

“…60 In case reports levosimendan shows a clear benefit during mitral valve surgery in patients with severe PH by reducing pulmonary artery pressure (PAP) and protecting RV contractility. 61,62 However, in another case report of patients with idiopathic pulmonary arterial hypertension, levosimendan failed to reduce PAP. 63 Levosimendan has been shown to be superior to dobutamine in some patient groups: in children with PH undergoing cardiac surgery 64 and in patients with biventricular failure levosimendan improves ejection fraction and tricuspid annular plane systolic excursion, decreasing systolic PAP.…”

Levosimendan: current status and future prospects

“…Importantly, levosimendan did not affect normal pulmonary vascular tone while effectively counteracting pulmonary vasoconstriction during pathologic conditions. In the perioperative period, several small studies reported beneficial effects of levosimendan on severe right ventricular dysfunction following mitral valve replacement [70] or heart transplantation [63,71].…”