Levosimendan in Two Neonates with Ischemic Heart Failure and Pulmonary Hypertension

Abstract

We report the successful and safe use of levosimendan, a new calcium-sensitizing agent with positive inotropic and vasodilatory action, in 2 critically ill term newborns with acute heart failure and pulmonary hypertension in the absence of any underlying heart malformation and/or previous cardiosurgical procedures. During the neonatal period, levosimendan may represent an ideal drug for immature myocardium characterized by a higher calcium-dependent contractility than in adults.

Outcome of Neonates with Vein of Galen Malformation Presenting with Severe Heart Failure: A Case Series

“…These drugs in fact reduce both pulmonary and systemic vascular resistance (SVR), and improve myocardial function. 9 MR, in particular, reducing SVR, promotes anterograde flow to the periphery and may reduce the relative steal through the VGAM; 10 terlipressin has also been demonstrated to improve pulmonary blood flow. 11 Major technical advances can offer also to moderately premature infants the chance to improve the hemodynamic condition and the opportunity of further procedures whenever the clinical status can allow them.…”

Utilisation du levosimendan chez l’enfant

“…Ceci est dû à la fois à l'effet inotrope positif mais aussi à la baisse significative des résistances pulmonaires. Ainsi, le levosimendan semble extrêmement intéressant en cas d'hypertension artérielle pulmonaire persistante du nouveau-né responsable d'insuffisance cardiaque sévère [49]. Sur un modèle porcin d'hypoxie-réoxygénation néonatale (deux heures de fraction inspirée en oxygène (FiO 2 ) entre 10 et 15 %, suivies d'une heure de FiO 2 à 21 %), une dose de 0,2 mg/kg/min permettait une amélioration significative de la fonction cardiaque sans hypotension systémique franche [50].…”

Inotropic Support in the NICU: Ever More Compounds in Search of Guidance?

“…age, weight, peripartal asphyxia, renal failure) into account. Similarly, reported pharmacodynamic outcome measures were mixed (cliniIn this edition of Neonatology , two studies about levosimendan in low cardiac output states in an animal hypoxic-ischemic encephalopathy model and in 2 human neonates with persistent pulmonary hypertension (PPHN) are published [1,2] . Levosimendan is a Ca 2+ sensitizer with positive inotrope and lusitrope effects.…”

“…Lusitrope effects occur by preventing diastolic calcium overload compared to other adrenergic agents so diastolic relaxation is improved without increased myocardial oxygen consumption. By opening ATP-sensitive potassium channels, vasodilation of the smooth muscles occurs with coronary vasodilation and decrease in systemic and pulmonary vascular resistance (PVR) [1][2][3] . These properties make this inotropic theoretically also useful in neonates.…”

“…However, no controlled studies have been published, and suggestions are based on animal research [6] . The levosimendan papers provide observational evidence that this compound should be added to this list [1,2] .…”