Use of Milrinone to Treat Cardiac Dysfunction in Infants with Pulmonary Hypertension Secondary to Congenital Diaphragmatic Hernia: A Review of Six PatientsPatel N.
Royal Children’s Hospital, Melbourne, Vic., Australia
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Background: Pulmonary hypertension and secondary cardiac dysfunction are important contributors of morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). Milrinone, a phosphodiesterase-3 inhibitor, may be useful in this setting for its combined actions as a pulmonary vasodilator and to improve systolic and diastolic function. Objectives: This study aimed to assess the effects of milrinone on cardiac function and pulmonary artery pressure in infants with CDH. Methods: A retrospective review of echocardiograms performed on infants with CDH who received milrinone was performed. Tissue Doppler imaging velocities were used to assess systolic and diastolic function. Pulmonary artery pressure was assessed from the pattern and velocity of ductal shunting. Results: Six infants with CDH and severe pulmonary hypertension were identified. Systolic and diastolic myocardial velocities were reduced in the right ventricle (RV) and interventricular septum (IVS) at baseline. In the 72 h after commencement of milrinone, there was a significant increase in early diastolic myocardial velocities in the RV, accompanied by increasing systolic velocities in the RV and IVS. Oxygenation index was significantly reduced, blood pressure unchanged, and ductal shunt velocity minimally altered over the same time period. Conclusions: Milrinone use was associated with an improvement in systolic and diastolic function in the RV, corresponding to an improvement in clinical status.
© 2012 S. Karger AG, Basel
- Sehgal A, Athikarisamy SE, Adamopoulos M: Global myocardial function is compromised in infants with pulmonary hypertension. Acta Paediatrica 2012;101:410–413.
- Patel N, Mills JF, Cheung MM: Assessment of right ventricular function using tissue Doppler imaging in infants with pulmonary hypertension. Neonatology 2009;96:193–199, discussion 200–202.
- Chen EP, Craig DM, Bittner HB, Davis RD, Van Trigt P: Pharmacological strategies for improving diastolic dysfunction in the setting of chronic pulmonary hypertension. Circulation 1998;97:1606–1612.
- McNamara PJ, Laique F, Muang-In S, Whyte HE: Milrinone improves oxygenation in neonates with severe persistent pulmonary hypertension of the newborn. J Crit Care 2006;21:217–222.
- Thebaud B, Tibboel D: Pulmonary hypertension associated with congenital diaphragmatic hernia. Cardiol Young 2009;19(suppl 1):49–53.
- Skinner JR, Boys RJ, Hunter S, Hey EN: Non-invasive assessment of pulmonary arterial pressure in healthy neonates. Arch Dis Child 1991;66:386–390.
- Dillon PW, Cilley RE, Mauger D, Zachary C, Meier A: The relationship of pulmonary artery pressure and survival in congenital diaphragmatic hernia. J Pediatr Surg 2004;39:307–312, discussion 312.
- Yamataka T, Puri P: Pulmonary artery structural changes in pulmonary hypertension complicating congenital diaphragmatic hernia. J Pediatr Surg 1997;32:387–390.
- Chin KM, Kim NH, Rubin LJ: The right ventricle in pulmonary hypertension. Coron Artery Dis 2005;16:13–18.
- Kinsella JP, Ivy DD, Abman SH: Pulmonary vasodilator therapy in congenital diaphragmatic hernia: acute, late, and chronic pulmonary hypertension. Semin Perinatol 2005;29:123–128.
- Noori S, Friedlich P, Wong P, Garingo A, Seri I: Cardiovascular effects of sildenafil in neonates and infants with congenital diaphragmatic hernia and pulmonary hypertension. Neonatology 2007;91:92–100.
- Filan PM, McDougall PN, Shekerdemian LS: Combination pharmacotherapy for severe neonatal pulmonary hypertension. J Paediatr Child Health 2006;42:219–220.
- Hunter L, Richens T, Davis C, Walker G, Simpson JH: Sildenafil use in congenital diaphragmatic hernia. Arch Dis Child Fetal Neonatal Ed. 2009;94:F467.
- Mohseni-Bod H, Bohn D: Pulmonary hypertension in congenital diaphragmatic hernia. Semin Pediatr Surg 2007;16:126–133.
- Chen EP, Bittner HB, Davis RD Jr, Van Trigt P 3rd: Milrinone improves pulmonary hemodynamics and right ventricular function in chronic pulmonary hypertension. Ann Thorac Surg 1997;63:814–821.
Binah O, Sodowick B, Vulliemoz Y, Danilo P Jr, Rosen M: The inotropic effects of amrinone and milrinone on neonatal and young canine cardiac muscle. Circulation 1986;73:III46–III51.
- Paradisis M, Evans N, Kluckow M, Osborn D: Randomized trial of milrinone versus placebo for prevention of low systemic blood flow in very preterm infants. J Pediatr 2009;154:189–195.
- Hoffman TM, Wernovsky G, Atz AM, Kulik TJ, Nelson DP, Chang AC, et al: Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 2003;107:996–1002.
- Bassler D, Choong K, McNamara P, Kirpalani H: Neonatal persistent pulmonary hypertension treated with milrinone: four case reports. Biol Neonate 2006;89:1–5.
- Nikitin NP, Witte KK: Application of tissue Doppler imaging in cardiology. Cardiology 2004;101:170–184.
- Mori K, Nakagawa R, Nii M, Edagawa T, Takehara Y, Inoue M, et al: Pulsed wave Doppler tissue echocardiography assessment of the long axis function of the right and left ventricles during the early neonatal period. Heart 2004;90:175–180.
Boucek RJ Jr, Martinez R: Echocardiographic determination of right ventricular function. Cardiol Young 2005;15(suppl 1):48–50.
- Paradisis M, Evans N, Kluckow M, Osborn D, McLachlan AJ: Pilot study of milrinone for low systemic blood flow in very preterm infants. J Pediatr 2006;148:306–313.
- Chang AC, Atz AM, Wernovsky G, Burke RP, Wessel DL: Milrinone: systemic and pulmonary hemodynamic effects in neonates after cardiac surgery. Crit Care Med 1995;23:1907–1914.
Bassler D, Kreutzer K, McNamara P, Kirpalani H: Milrinone for persistent pulmonary hypertension of the newborn. Cochrane Database Syst Rev 2010;11:CD007802.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.