[Intensive care for newborns and babies of the first year of life with acute heart failure after cardiosurgical interventions]

Abstract

After cardiosurgical interventions, the incidence of low cardiac output syndrome (LCOS) is 3-10% depending on age and surgery. The basis for management of patients with LCOS and high pulmonary hypertension is to maintain low total peripheral vascular resistance and to exclude volume overload. Due to the fact that the Russian Federation lacked phosphodiesterase (PDE) III inhibitors that are basic intensive care drugs in pediatric surgery in the West, levosimendan was used as an inodilator in the complex intensive care for postoperative LCOS in 75 infants aged 3 days to 2 years 10 months in October to December 2007. Before drug infusion, left ventricular ejection fraction (LVEF) varied from 17 to 29% (21 +/- 7%), left atrial pressure (LAP) was 25 +/- 2.82 (16-30 mm Hg). During levosimendan administration, the authors analyzed the following hemodynamic parameters: rate, blood pressure, central venous pressure (CVP), LAP, and LVEF by echocardiography, as well as the frequency of side effects and mortality rates. During levosimendan infusion after transient hypotension at the beginning of the drug administration, following 12 hours there was a significant increment in mean BP from 42 to 53 mm Hg (p < 0.05). Left ventricular (LV) preload changes as a significant reduction in LAP (from 25 to 17 mm Hg; p < 0.05) developed much earlier: 6 hours after initiation of levosimendan administration. During the drug administration, CVP values were unchanged. LVEF significantly rose from 21 to 27% following 12 hours of levosimendan therapy start. The major adverse reaction was a tendency towards systemic hypotension within the first hour of levosimedan infusion requiring bolus injection of 20% albumin in 11 cases and infusion of epinephrine (0.03-0.05 microg/kg/min) in 14 cases. Thus, levosimedan may be used as an inodilator in pediatric cardiosurgery as an alternative to PDE III inhibitors in LCOS after surgical correction for congenital heart disease (CHD), accompanied by LV hypoplasia, after surgical correction of CHD with baseline low LVEF, as well as a basic drug during extracorporeal circulation and after its cessation.