[Treatment of acute low cardiac output syndrome after surgery of congenital heart defects: value of enoximone]

Z Kardiol. 1994:83 Suppl 2:83-9.
[Article in German]

Abstract

Children undergoing cardiac surgery are at additional risk for postoperative low cardiac output syndrome (LCOS). Anticipation of the syndrome from preoperative hemodynamic condition, surgical procedure, and adverse intraoperative events is a key to successful postoperative management. Inotropic support is primarily based on catecholamines. However, uncoupling of human cardiac beta-adrenoceptors during cardiopulmonary bypass with cardioplegic cardiac arrest may be the reason why many patients respond only weakly to beta-adrenoceptor agonists. Phosphodiesterase (PDE) inhibitors act by reducing intracellular breakdown of cAMP, which is elevated independently from beta-receptors. The use of PDE-inhibitors might be advantageous in patients with uncoupled beta-adrenoceptors, as occurs after cardiopulmonary bypass. In addition, PDE-inhibitors can prevent further downregulation of the adrenoceptors due to avoiding prolonged therapy by beta-agonists. In this context, the addition of enoximone, a PDE-inhibitor, to adrenergic agents has been found useful in increasing cardiac output in children with catecholamine-resistant LCO, as well as in children with compensated hemodynamics during catecholamine therapy.

Publication types

  • English Abstract

MeSH terms

  • Cardiac Output, Low / drug therapy*
  • Cardiac Output, Low / physiopathology
  • Child
  • Child, Preschool
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Enoximone / administration & dosage*
  • Enoximone / adverse effects
  • Epinephrine / administration & dosage
  • Epinephrine / adverse effects
  • Female
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery*
  • Hemodynamics / drug effects*
  • Hemodynamics / physiology
  • Humans
  • Infant
  • Infusions, Intravenous
  • Male
  • Myocardial Contraction / drug effects
  • Myocardial Contraction / physiology
  • Nitroglycerin / administration & dosage
  • Nitroglycerin / adverse effects

Substances

  • Enoximone
  • Nitroglycerin
  • Epinephrine