Introduction
Levosimendan (Lev) is a new calcium sensitizer and K-ATP channel opener. The documentation regarding this drug is one of the largest ever on the safety and efficacy of a new pharmacological agent in acute heart failure syndromes in adult population. Its use in paediatric is limited to successful weaning from biventricular mechanical support in case reports or small trials conducted in the immediate postoperative period. We report our experience of using (Lev) during refractory cardiogenic shock (RCS) in infants.
Patients and Methods
Four infants aged 2?4 months and suffering from hypokinetic dilated cardiomyopathy) were included in this study. All presented with uncontrolled RCS (LVEF < 20 % ) despite conventional inotropes treatment. Lev was intended as a last resort before ECMO. The effectiveness of treatment was monitored by measuring the echocardiographic left ventricular ejection fraction (LVEF) and plasma BNP assay before and 8 days after administration. A total of 15 injections of Lev were realized and studied.
Results
Mean LVEF before and 8 days after administration of Lev significantly increase from 19.75 % +/?1.7 to 33 +/?2.95 (p < 0.01) and mean BNP level decrease from 2267 pg/ml +/?518 to 1673 +/?372 (p < 0.08). These children could benefit from additional treatments of Lev in order to wean amines and defer the circulatory support. In one of these, a total of 6 cycles was necessary without the use of circulatory support for an improvement. In the 4 patients studied, the outcome was favorable. Figure 1 illustrates the individual changes in LVEF and BNP after each Lev injection.
Conclusion
During the refractory cardiogenic shock of the child with hypokinetic dilated cardiomyopathy, levosimendan may improve myocardial function allowing weaning of conventional inotropes and circulatory support. Re-injection may also be necessary. Randomized studies with larger number of patients are needed to confirm these very encouraging results.
