DOI QR코드

DOI QR Code

Successful Opening of Ductus Arteriosus with Milrinone in a Newborn with Tetralogy of Fallot and Pulmonary Atresia

  • Won, Chong-Bock (Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science) ;
  • Kim, Min-Young (Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science) ;
  • Choi, Duk-Young (Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science) ;
  • Cho, Hye-Jung (Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science) ;
  • Shim, So-Yeon (Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science) ;
  • Son, Dong-Woo (Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science)
  • 발행 : 2011.11.30

초록

폐동맥폐쇄가 동반된 팔로네증은 팔로네증 중에 가장 심한 형태이다. 이런 종류의 선천성 심질환에서 폐혈액 순환을 지속하기 위하여 동맥관 개존을 유지하는 것은 생명을 구하는 매우 중요한 치료이다. Milrinone은 선택적 인산이에스테르효소 3 억제제이며 강력한 혈관 확장제로 알려져 있다. 저자들은 폐동맥 폐쇄가 동반된 팔로네증 신생아에서 폐순환을 지속시키기 위하여 동맥관 개방을 유지하는 치료로 milrinone을 성공적으로 사용한 증례를 보고한다. Milrinone은 동맥관 개방효과뿐 아니라, 심근수축 촉진, 이완 촉진, 폐혈관 확장 효과가 있으며 부작용은 심하지 않아 더 이로운 치료방법이 될 가능성이 있다. Milrinone의 치료효과를 밝히기 위하여 더 많은 치료증례 조사와 타 약제와의 비교 연구 등이 필요하다.

Tetralogy of Fallot (TOF) assumes its' most severe form when accompanied by pulmonary atresia (PA). Preserving the patent ductus arteriosus to maintain pulmonary blood flow is life-saving for patients with this congenital heart disease. Milrinone, a selective phosphodiesterase III inhibitor, is a potent vasodilator. Here, we report the successful use of milrinone for a newborn infant with TOF and PA for keeping the ductus arteriosus open and thereby maintaining pulmonary circulation. Milrinone is a useful drug because of its inotropic, lusitropic, and pulmonary vasodilating effects, in addition to its ability to keep the ductus arteriosus open and its relatively mild side-effects. Case series and comparative studies will be needed in the future to verify the effectiveness of this drug.

키워드

참고문헌

  1. Hayes JS, Bowling N, Boder GB, Kauffman R. Molecular basis for the cardiovascular activities of amrinone and AR-L57. J Pharmacol Exp Ther 1984;230:124-32.
  2. 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;23:1907-14. https://doi.org/10.1097/00003246-199511000-00018
  3. In DK, Yang SW, Hong HJ, Choi DY, Sun YH, Ryoo E, et al. Experience of milrinone treatment for persistent pulmonary hypertension of the newborn. J Korean Soc Neonatol 2006;13:201- 8.
  4. 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;154:189-95. https://doi.org/10.1016/j.jpeds.2008.07.059
  5. Bernstein D. Tetralogy of Fallot with pulmonary atresia. In: Kliegman RM, Stanton BF, St Geme III JW, Schor NF, Behrman RE, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier Saunders, 2011:1578-80.
  6. Schneider DJ, Moore JW. Patent ductus arteriosus. Circulation 2006;114:1873-82. https://doi.org/10.1161/CIRCULATIONAHA.105.592063
  7. Kaufman MB, El-Chaar GM. Bone and tissue changes following prostaglandin therapy in neonates. Ann Pharmacother 1996;30:269-74, 277.
  8. Lewis AB, Freed MD, Heymann MA, Roehl SL, Kensey RC. Side effects of therapy with prostaglandin E1 in infants with critical congenital heart disease. Circulation 1981;64:893-8. https://doi.org/10.1161/01.CIR.64.5.893
  9. Jentzer JH, Lejemtel TH, Sonnenblick EH, Kirk ES. Beneficial effect of amrinone on myocardial oxygen consumption during acute left ventricular failure in dogs. Am J Cardiol 1981;48:75-83. https://doi.org/10.1016/0002-9149(81)90574-9
  10. LeJemtel TH, Scortichini D, Levitt B, Sonnenblick EH. Effects of phosphodiesterase inhibition on skeletal muscle vasculature. Am J Cardiol 1989;63:27A-30A. https://doi.org/10.1016/0002-9149(89)90389-5
  11. Silver PJ, Harris AL, Canniff PC, Lepore RE, Bentley RG, Hamel LT, et al. Phosphodiesterase isozyme inhibition, activation of the cAMP system, and positive inotropy mediated by milrinone in isolated guinea pig cardiac muscle. J Cardiovasc Pharmacol 1989;13:530-40.
  12. Wynands JE. Amrinone: is it the inotrope of choice? J Cardiothorac Anesth 1989;3(6 Suppl 2):45-57.
  13. Ramamoorthy C, Anderson GD, Williams GD, Lynn AM. Pharmacokinetics and side effects of milrinone in infants and children after open heart surgery. Anesth Analg 1998;86:283-9.
  14. 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. https://doi.org/10.1161/01.CIR.0000051365.81920.28
  15. Toyoshima K, Momma K, Imamura S, Nakanishi T. In vivo dilatation of the fetal and postnatal ductus arteriosus by inhibition of phosphodiesterase 3 in rats. Biol Neonate 2006;89:251-6. https://doi.org/10.1159/000089954
  16. Sehgal A, Francis JV, Lewis AI. Use of milrinone in the management of haemodynamic instability following duct ligation. Eur J Pediatr 2011;170:115-9. https://doi.org/10.1007/s00431-010-1296-2
  17. Sehgal A. Haemodynamically unstable preterm infant: an unresolved management conundrum. Eur J Pediatr 2011;170:1237-45. https://doi.org/10.1007/s00431-011-1435-4