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Age-dependent effects of milrinone and levosimendan on ventricular function and haemodynamics in newborn and mature pigs

Published online by Cambridge University Press:  10 May 2011

Janus A. Hyldebrandt ,
Signe H. Larsen ,
Michael R. Schmidt ,
Vibeke E. Hjortdal  and
Hanne B. Ravn
Janus A. Hyldebrandt*
Affiliation:
Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Aarhus N, Denmark Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Aarhus N, Denmark
Signe H. Larsen
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus N, Denmark
Michael R. Schmidt
Affiliation:
Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark
Vibeke E. Hjortdal
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus N, Denmark
Hanne B. Ravn
Affiliation:
Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Aarhus N, Denmark
*
Correspondence to: J. A. Hyldebrandt MD, Department of Anesthesiology and Intensive Care, Aarhus University Hospital Skejby, 8200 Aarhus N, Denmark. Tel: +45 21210204; Fax: +45 89498750; E-mail: janusadlerhyldebrandt@gmail.com
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Abstract

Inodilators are used in the treatment of low cardiac output, mainly after cardiac surgery. At present, there is little knowledge of the effect of inodilators in the newborn heart. Immediately after birth and in the neonatal period, the metabolism and physiology of the heart undergo major changes. We hypothesised that effects of the inodilators milrinone and levosimendan on myocardial contractility and haemodynamics under normal physiological conditions were age dependent. Animal studies were conducted on 48 pigs using a closed-chest biventricular conductance catheter method. Pigs in two age groups, that is, 5–6 days and 5–6 weeks, were assigned to milrinone, levosimendan, or a control group. We observed that both milrinone – 19.2% with a p value of 0.05 – and levosimendan – 25.7% with a p value of 0.03 compared with the control group increased cardiac output, as well as myocardial contractility with a maximum pressure development over time: milrinone 28.2%, p = 0.01 and levosimendan 19.4%, p = 0.05. Milrinone improved diastolic performance (p < 0.05) in the left ventricle in the 5–6-week-old animals. In the newborn animals, neither of the inodilators increased ventricular contractility or cardiac output; however, we observed a significant decrease in the mean arterial pressure: milrinone 34.6%, p < 0.01 and levosimendan 30.1%, p = 0.02. Both inodilators demonstrated age-dependent haemodynamic effects, and it is noteworthy that neither milrinone nor levosimendan was able to increase cardiac output in the newborn heart.

Keywords

Levosimendanmilrinonecardiac outputlowinfantnewbornhaemodynamicsmyocardial contraction
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 5 , 09 September 2011 , pp. 518 - 527
Copyright
Copyright © Cambridge University Press 2011

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