Use of levosimendan in hemodynamic management of heart failure in two neonates with intracranial arteriovenous shunts: a case series.
Case report
Cerebral arteriovenous malformations
Galen vein malformation
NICU
NIRS
Neonate
PRAM
Journal
Italian journal of pediatrics
ISSN: 1824-7288
Titre abrégé: Ital J Pediatr
Pays: England
ID NLM: 101510759
Informations de publication
Date de publication:
15 Oct 2023
15 Oct 2023
Historique:
received:
04
05
2023
accepted:
21
09
2023
medline:
23
10
2023
pubmed:
16
10
2023
entrez:
15
10
2023
Statut:
epublish
Résumé
The hemodynamic status of newborns with intracranial arteriovenous shunts (AVSs) may be extremely complex. Mini-invasive hemodynamic monitoring through innovative techniques such as Near-Infrared Spectroscopy (NIRS) and Pressure Recording Analytical Method (PRAM) may help in understanding hemodynamics in newborns with AVSs. Levosimendan is a calcium sensitizer and inodilator, and it is known to improve ventricular function, but its use in newborns is limited. In our cases, we evaluated the effect of levosimendan on hemodynamics through NIRS and PRAM. Herein, we report the cases of two neonates with intracranial arteriovenous shunts, in whom we used levosimendan to manage cardiac failure refractory to conventional treatment. Levosimendan was used at a dosage of 0.1 mcg/kg/min for 72 h. Combined use of NIRS and PRAM helped in real-time monitoring of hemodynamic effects; in particular, levosimendan determined significant improvement in myocardium contractility as well as a reduction of heart rate. In two neonatal cases of AVSs, levosimendan led to an overall hemodynamic stabilization, documented by the combination of NIRS and PRAM. Our results suggest introducing levosimendan as a second-line treatment in cases of severe cardiac dysfunction due to AVSs without improvement using standard treatment strategies. Future prospective and larger studies are highly warranted.
Sections du résumé
BACKGROUND
BACKGROUND
The hemodynamic status of newborns with intracranial arteriovenous shunts (AVSs) may be extremely complex. Mini-invasive hemodynamic monitoring through innovative techniques such as Near-Infrared Spectroscopy (NIRS) and Pressure Recording Analytical Method (PRAM) may help in understanding hemodynamics in newborns with AVSs. Levosimendan is a calcium sensitizer and inodilator, and it is known to improve ventricular function, but its use in newborns is limited. In our cases, we evaluated the effect of levosimendan on hemodynamics through NIRS and PRAM.
CASE PRESENTATION
METHODS
Herein, we report the cases of two neonates with intracranial arteriovenous shunts, in whom we used levosimendan to manage cardiac failure refractory to conventional treatment. Levosimendan was used at a dosage of 0.1 mcg/kg/min for 72 h. Combined use of NIRS and PRAM helped in real-time monitoring of hemodynamic effects; in particular, levosimendan determined significant improvement in myocardium contractility as well as a reduction of heart rate.
CONCLUSION
CONCLUSIONS
In two neonatal cases of AVSs, levosimendan led to an overall hemodynamic stabilization, documented by the combination of NIRS and PRAM. Our results suggest introducing levosimendan as a second-line treatment in cases of severe cardiac dysfunction due to AVSs without improvement using standard treatment strategies. Future prospective and larger studies are highly warranted.
Identifiants
pubmed: 37840126
doi: 10.1186/s13052-023-01537-1
pii: 10.1186/s13052-023-01537-1
pmc: PMC10577993
doi:
Substances chimiques
Simendan
349552KRHK
Cardiotonic Agents
0
Hydrazones
0
Pyridazines
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
141Subventions
Organisme : Ministero della Salute
ID : Current Research funds
Informations de copyright
© 2023. Società Italiana di Pediatria.
Références
J Perinatol. 2007 Jul;27(7):460-3
pubmed: 17592491
Pediatr Res. 2023 Jan;93(1):39-48
pubmed: 35422084
Pediatr Crit Care Med. 2012 Sep;13(5):542-8
pubmed: 22622649
BMJ Case Rep. 2013 Jan 23;2013:
pubmed: 23349169
Clin Perinatol. 2019 Jun;46(2):273-290
pubmed: 31010560
Neuroimaging Clin N Am. 2013 Nov;23(4):757-70
pubmed: 24156863
Pediatr Res. 2006 Nov;60(5):624-9
pubmed: 16988189
Pediatr Crit Care Med. 2021 Jul 1;22(7):e382-e390
pubmed: 33591071
Semin Fetal Neonatal Med. 2022 Aug;27(4):101368
pubmed: 35798649
Am J Perinatol. 2019 Jan;36(2):169-175
pubmed: 29991070
Eur Heart J Suppl. 2018 Dec;20(Suppl I):I2-I10
pubmed: 30555279
J Pediatr Intensive Care. 2013 Sep;2(3):95-103
pubmed: 31214430
CASE (Phila). 2017 Oct 19;1(6):242-244
pubmed: 30062291
AJNR Am J Neuroradiol. 2017 Dec;38(12):2308-2314
pubmed: 28982789
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5312-5317
pubmed: 33508985
Interact Cardiovasc Thorac Surg. 2016 Dec;23(6):919-923
pubmed: 27481679
J Matern Fetal Neonatal Med. 2011 Oct;24 Suppl 1:56-8
pubmed: 21942593
J Neurosurg Pediatr. 2019 Feb 22;:1-9
pubmed: 30797209
Arch Dis Child Fetal Neonatal Ed. 2002 Sep;87(2):F144-9
pubmed: 12193525
Heart Lung Vessel. 2013;5(4):227-45
pubmed: 24364017
Int J Cardiol. 2009 Feb 20;132(2):e60-2
pubmed: 18022260