Use of levosimendan in hemodynamic management of heart failure in two neonates with intracranial arteriovenous shunts: a case series

Italian Journal of Pediatrics

Case Report

Claudia Columbo¹  Francesca Landolfo¹  Irma Capolupo¹  Domenico Umberto De Rose¹  Flaminia Pugnaloni¹  Alessandra Santisi¹  Andrea Dotta¹  Maria Paola Ronchetti¹  Paola Giliberti¹  Ludovica Martini¹  Carlo Gandolfo²  Luca Di Chiara³  Alessandra Toscano⁴ 

[1] Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165, Rome, Italy;Neuroradiology Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165, Rome, Italy;Pediatric Cardiac Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165, Rome, Italy;Perinatal Cardiology Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165, Rome, Italy;

关键词: PRAM;    NIRS;    Neonate;    NICU;    Galen vein malformation;    Cerebral arteriovenous malformations;    Case report;   

DOI  :  10.1186/s13052-023-01537-1

 received in 2023-05-04, accepted in 2023-09-21,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe 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 presentationHerein, 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.ConclusionIn 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.

【 授权许可】

CC BY   
© Società Italiana di Pediatria 2023

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