Iacobelli Roberta, Ricci Zaccaria, Marinari Eleonora, Haiberger Roberta, Di Molfetta Arianna, Toscano Alessandra, Di Chiara Luca
Pediatric Cardiology Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Interact Cardiovasc Thorac Surg. 2020 Apr 1;30(4):623-629. doi: 10.1093/icvts/ivz319.
The use of levosimendan for paediatric patients with low cardiac output after congenital heart surgery has been recently described. We sought to evaluate ventriculo-arterial coupling (VAC) and other ventricular energetic parameters before and after 72 h from levosimendan start in infants with single-ventricle physiology and cardiac failure after palliation with Norwood or hybrid procedures.
In this single-centre retrospective study, 9 consecutive patients affected by hypoplastic left heart syndrome-like anatomy were retrospectively analysed. Systolic elastance, diastolic elastance, arterial elastance, VAC and cardiac mechanical efficiency were calculated by measuring, through 2-dimensional echocardiography, end-systolic volume and end-diastolic volume and by recording mean arterial pressure and central venous pressure.
The median (range) weight and age were 2.8 (2.3-6) kg and 16.5 (6-116) days, respectively. After 72 h from levosimendan start, end-systolic volume significantly decreased (-1 ml, -3.2 to -0.1, P = 0.007), whereas mean arterial pressure and end-diastolic volume remained stable. Heart rate showed a significant decrease (-28 beats/min, -41 to 22, P = 0.008). Systolic elastance (2.9 mmHg/ml, 0.4-5.4, P = 0.008), arterial elastance (-5.9, -24 to -0.5, P = 0.038), VAC (-0.86, -1.5 to -0.16, P = 0.009) and cardiac mechanical efficiency (0.18, 0.03-0.22, P = 0.008) differences also showed significant modifications.
In a small case series of patients with single-ventricle physiology, levosimendan showed to improve contractility and optimize VAC, with a reduction of heart rate. Monitoring of VAC and ventricular energetics can be an interesting aspect to improve the management of heart failure in infants with univentricular anatomy.
近期已有关于左西孟旦用于先天性心脏病手术后心输出量低的儿科患者的报道。我们试图评估单心室生理且经诺伍德手术或杂交手术姑息治疗后出现心力衰竭的婴儿在开始使用左西孟旦72小时前后的心室动脉耦联（VAC）及其他心室能量参数。
在这项单中心回顾性研究中，对9例患有类似左心发育不全综合征解剖结构的连续患者进行了回顾性分析。通过二维超声心动图测量收缩末期容积和舒张末期容积，并记录平均动脉压和中心静脉压，计算收缩弹性、舒张弹性、动脉弹性、VAC和心脏机械效率。
体重中位数（范围）为2.8（2.3 - 6）kg，年龄中位数（范围）为16.5（6 - 116）天。开始使用左西孟旦72小时后，收缩末期容积显著降低（-1 ml，-3.2至-0.1，P = 0.007），而平均动脉压和舒张末期容积保持稳定。心率显著降低（-28次/分钟，-41至22，P = 0.008）。收缩弹性（2.9 mmHg/ml，0.4 - 5.4，P = 0.008）、动脉弹性（-5.9，-24至-0.5，P = 0.038）、VAC（-0.86，-1.5至-0.16，P = 0.009）和心脏机械效率（0.18，0.03 - 0.22，P = 0.008）的差异也显示出显著变化。
在一小例单心室生理患者系列中，左西孟旦显示出可改善收缩性并优化VAC，同时降低心率。监测VAC和心室能量学可能是改善单心室解剖结构婴儿心力衰竭管理的一个有趣方面。
