Introduction. Levosimendan is a novel positive inotropic agent which,
improves myocardial contractility through its calcium-sensitizing action,
without causing an increase in myocardial oxygen demand. Also, by opening
ATP-sensitive potassium channels, it causes vasodilatation with the reduction
in both afterload and preload. Because of the long halflife, its effects last
for up 7 to 9 days after 24-hour infusion. Case report. We presented three
patients 2, 15 and 17 years old. All the patients had severe acute
deterioration of the previously diagnosed chronic heart failure (dilatative
cardiomyopathy; univentricular heart with bidirectional Glenn anastomosis and
restrictive bulboventricular foramen; bacterial endocarditis on artificial
aortic valve with severe stenosis and regurgitation). Signs and symptoms of
severe heart failure, cardiomegaly (cardio-thoracic index 0.65) and left
ventricular dilatation (end-diastolic diameter z-score 2.6; 4.1 and 4.0) were
confirmed on admission. Also, myocardial contractility was poor with ejection
fraction (EF - 27%, 25%, 35%), fractional shortening (FS - 13%, 11%, 15%) and
stroke volume (SV - 40, 60, 72 mL/m2). The treatment with standard
intravenous inotropic agents resulted in no improvement but in clinical
deterioration. Thus, standard intravenous inotropic support was stopped and
levosimendan treatment was introduced. All the patients received a continuous
24-h infusion 0.1 ?g/kg/min of levosimendan. In a single patient an initial
loading dose of 11 ?g/kg over 10 min was administrated, too. Levosimendan
treatment resulted in both clinical and echocardiography improvement with the
improved EF (42%, 34%, 44%), FS (21%, 16%, 22%) and SV (59, 82, 93 mL/m2).
Hemodynamic improvement was registered too, with the reduction in heart rate
in all the treated patients from 134-138 bpm before, to less than 120 bpm
after the treatment. These parameters were followed by the normalization of
lactate levels. Nevertheless, left ventricular end-diastolic diameter did not
change after the levosimendan treatment. Conclusion. Our initial experience
demonstrates that administration of levosimendan in patients with severe
chronic heart failure not responsive to standard intravenous inotropic
treatment might result in a significant clinical and hemodynamic improvement
and that, in selected patients, it might be life saving. According to our
best knowledge patients presented are the first pediatric patients treated
with levosimendan in our country.
Univentricular heart with common atria. First historical cases
