Long-Term Support with Milrinone Prior to Cardiac Transplantation in a Neonate with Left Ventricular Noncompaction Cardiomyopathy

McMahon, C. J.; Murchan, H.; Prendiville, Terence; Burch, Michael

doi:10.1007/s00246-007-0020-0

Cited by 8 publications

(7 citation statements)

References 9 publications

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“…The left atrial ejection force as a marker of the left atrial systolic function may be increased in LVHT patients, suggesting compensating left atrial work against the dysfunctioning LV [86]. TDI velocities of the C-layer may be significantly reduced already in asymptomatic LVHT patients and thus may help to identify patients at risk for an adverse outcome [87][88][89]. STE may show twisting of the base and apex of the LV in the same direction when compared to controls and patients with dCMP where the LV rotation is clockwise on the basal level and counter-clockwise on the apical level [33].…”

Section: Echocardiographic Abnormalitiesmentioning

confidence: 94%

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Left ventricular non-compaction and its cardiac and neurologic implications

Finsterer

2010

Heart Fail Rev

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Left ventricular non-compaction, also known as left ventricular hypertrabeculation (LVHT), is a morphological abnormality of the left ventricular myocardium, characterised by a meshwork of myocardial strings, interlacing, and orderless in arrangement. LVHT is most frequently located in the apex and the lateral wall and may occur with or without other congenital or acquired cardiac abnormalities. LVHT is believed to be congenital in the majority of the cases but may develop during life in single cases (acquired LVHT). Congenital LVHT is believed to result from defective late-stage embryonic development of the myocardial architecture. The pathogenesis of acquired LVHT remains speculative. LVHT is most frequently found on transthoracic echocardiography and cardiac MRI but may be visualised also with other imaging techniques. In the majority of the cases, LVHT is associated with hereditary cardiac, neuromuscular, non-cardiac/non-muscle disease, or chromosomal aberrations. In the majority of the cases, LVHT is complicated by ventricular arrhythmias, systolic dysfunction, cardiac embolism, or sudden cardiac death. LVHT per se does not require a specific treatment. Only in case of complications, such as ventricular arrhythmias, cardioembolism, or systolic dysfunction, adequate therapy is indicated. Though initially assessed as poor, the prognosis of LVHT has meanwhile improved, most likely due to the increased awareness for the abnormality and the timely administration of adequate therapy.

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Section: Echocardiographic Abnormalitiesmentioning

confidence: 94%

“…Single patients have been reported to respond to milrinone [87]. In case of intractable heart failure and systolic dysfunction, despite optimal medical treatment, and mechanical desynchrony (widened QRS, reduced TDI velocities), CRT is indicated [88].…”

Section: Prevention Of Heart Failurementioning

confidence: 99%

Left ventricular non-compaction and its cardiac and neurologic implications

Finsterer

2010

Heart Fail Rev

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“…The utility of chronic continuous milrinone infusion for heart failure as bridge therapy to heart transplantation was proposed in a recent adult study 6). McMahon et al29) demonstrated that long-term support with milrinone was safe and effective in infants with cardiomyopathy awaiting heart transplantation. Outpatient continuous parenteral inotropic therapy, including milrinone, has also been used in inotropic-dependent children with advanced heart failure 30).…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of the Off-Label Use of Milrinone in Pediatric Patients with Heart Diseases

et al. 2014

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Background and ObjectivesMilrinone is often used in children to treat acute heart failure and prevent low cardiac output syndrome after cardiac surgery. Due to the lack of studies on the long-term milrinone use in children, the objective of this study was to assess the safety and efficacy of the current patterns of milrinone use for ≥3 days in infants and children with heart diseases.Subjects and MethodsWe retrospectively reviewed the medical records of patients aged <13 years who received milrinone for ≥3 days from January 2005 to December 2012. Patients' characteristics including age, sex, height, weight, and body surface area were recorded. The following parameters were analyzed to identify the clinical application of milrinone: initial infusion rate, maintenance continuous infusion rate, total duration of milrinone therapy, and concomitantly infused inotropes. The safety of milrinone was determined based on the occurrence of adverse events such as hypotension, arrhythmia, chest pain, headache, hypokalemia, and thrombocytopenia.ResultsWe assessed 730 admissions (684 patients) during this period. Ventricular septal defects were the most common diagnosis (42.4%) in these patients. Milrinone was primarily used after cardiac surgery in 715 admissions (97.9%). The duration of milrinone treatment varied from 3 to 64.4 days (≥7 days in 149 admissions). Ejection fraction and fractional shortening of the left ventricle improved in patients receiving milrinone after cardiac surgery. Dose reduction of milrinone due to hypotension occurred in only 4 admissions (0.5%). Although diverse arrhythmias occurred in 75 admissions (10.3%), modification of milrinone infusion to manage arrhythmia occurred in only 3 admissions (0.4%). Multivariate analysis indicated that the development of arrhythmia was not influenced by the pattern of milrinone use.ConclusionMilrinone was generally administered for ≥3 days in children with heart diseases. The use of milrinone for ≥3 days was effective in preventing low cardiac output after cardiac surgery when combined with other inotropes, suggesting that milrinone could be safely employed in pediatric patients with heart diseases.

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“…However, not all centers, nor geographical areas for that matter, have readily accessible transplant facilities. One study reported the successful long term support of a neonatal patient with INVM on milrinone while she awaited cardiopulmonary transplantation 22 …”

Section: Treatmentmentioning

confidence: 99%

“…One study reported the successful long term support of a neonatal patient with INVM on milrinone while she awaited cardiopulmonary transplantation. 22…”

Section: Treatmentmentioning

confidence: 99%