Successful treatment of dilative cardiomyopathy in a 12-year-old girl using the calcium sensitizer levosimendan after weaning from mechanical biventricular assist support

Single-centred experience with levosimendan in paediatric decompensated dilated cardiomyopathy

“…Because this agent does not increase oxygen consumption of cardiomyocytes, it appears to be an emerging tool for the treatment of paediatric heart failure [9,[18][19][20]. Although Suominen et al reported the good perception of physicians who used levosimendan in a paediatric population [20], no previous study has analysed the effect of levosimendan on biological and echocardiographic variables in a population of children with DCM in end-stage heart failure.…”

“…These results have encouraged many European centres to use levosimendan routinely to prevent postoperative low cardiac output syndrome [17]. In a population of children with DCM and chronic heart failure, the use of levosimendan was rarely reported [18,19], despite a shared perception of efficacy among physicians who tried it [20]. Finally, one study has advocated rotative inotrope therapy, with levosimendan infusions, in children with decompensated heart failure [21].…”

Advances in cardiac intensive care

“…The literature regarding clinical experience in pediatrics has been limited. There are two case reports, one in a patient with dilated cardiomyopathy [53] and the other in a patient with heart failure after the biventricular repair of ventricular septal defect with hypoplastic aortic arch [54]. In both reports, levosimendan was associated with improved ventricular function and a successful wean from hemodynamic and pulmonary support.…”

Inotropic Support in the NICU: Ever More Compounds in Search of Guidance?

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Following reports on positive effects in adult low cardiac output syndrome (LCOS), case reports and series on 106 pediatric patients with almost exclusively congenital heart disease have been published since 2004 ( table 1 ) [7][8][9][10][11][12][13][14][15][16][17] . In all but 2 studies, levosimendan was used as rescue after conventional therapy failed.

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“…Indications in these 2 studies were LCOS prevention in congenital heart disease; only one study had a randomized doubleblind prospective design (randomization before cardiopulmonary bypass, levosimendan or milrinone). When reading through table 1 , the variability in dosing regimens and primary pharmacodynamic end points is extensive [7][8][9][10][11][12][13][14][15][16][17] .From a clinical pharmacology perspective, this is another illustration of a compound that dripped into our units without appropriated evaluation. Without pharmacokinetic studies (including metabolites for this specific compound), it is unclear to what extent simple extrapolation of adult or pediatric drug dosing takes covariates of neonatal pharmacokinetics (e.g.…”