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Circulating cyclic adenosine monophosphate concentrations in milrinone treated paediatric patients after congenital heart surgery

Published online by Cambridge University Press:  03 February 2021

Katja M. Gist*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Colorado Denver, Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
Armin Korst
Affiliation:
Research Institute, Children’s Hospital Colorado, Aurora, CO, USA
Stephanie J. Nakano
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Colorado Denver, Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
Brian L. Stauffer
Affiliation:
Department of Medicine, Division of Cardiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
Anis Karimpour-Fard
Affiliation:
Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
Wenru Zhou
Affiliation:
Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
Kristen Campbell
Affiliation:
Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
Michael F. Wempe
Affiliation:
Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
Carmen C. Sucharov
Affiliation:
Department of Medicine, Division of Cardiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
Shelley D. Miyamoto
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Colorado Denver, Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
*Corresponding
Address for correspondence: Katja M Gist, DO, MSCS, 13123 E 16th Ave, B100, Aurora, CO 80045, USA. Tel: +1 720 777 3614; Fax: +1 720 777 7290. E-mail: Katja.gist@childrenscolorado.org

Abstract

Background:

Milrinone is a phosphodiesterase type 3 inhibitor that results in a positive inotropic effect in the heart through an increase in cyclic adenosine monophosphate. The purpose of this study was to evaluate circulating cyclic adenosine monophosphate and milrinone concentrations in milrinone treated paediatric patients undergoing congenital heart surgery.

Methods:

Single-centre prospective observational pilot study from January 2015 to December 2017 including children aged birth to 18 years. Milrinone and circulating cyclic adenosine monophosphate concentrations were measured at four time points through the first post-operative day and compared between patients with and without low cardiac output syndrome, defined using clinical and laboratory criteria.

Results:

Fifty patients were included. Nine (18%) developed low cardiac output syndrome. For all patients, 22% had single ventricle heart disease. The density and distribution of cyclic adenosine monophosphate concentrations varied between those with and without low cardiac output syndrome but were not significantly different. Milrinone concentrations increased in all patients. Paired t-tests demonstrated an increase in circulating cyclic adenosine monophosphate concentrations during the post-operative period among patients without low cardiac output syndrome.

Conclusions:

In this prospective observational study, circulating cyclic adenosine monophosphate concentrations increased in those without low cardiac output syndrome during the first 24 post-operative hours and milrinone concentrations increased in all patients. Further study of the utility of cyclic adenosine monophosphate concentrations in milrinone treated patients is necessary.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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