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Submitted: 16 May 2007 Modified: 25 June 2012
HERDIN Record #: PCHRDPC020345

Echocardiographic evaluation of cardiac function of children in NYHA class III-IV undergoing mitral valve surgery given milrinone bolus prior to weaning from CPB.

 Casas Ma. Lourdes SR,
 Balderas Juliet J,
 Hilario Evelyn Antho

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SIGNIFICANCE OF THE STUDY: Children in NYHA Class III-IV with mitral valve disease from severe mitral regurgitation have increased morbidity despite surgery due to preoperative LV dysfunction from a markedly increased end-diastolic LV dimension. The vasodilator and inotropic effects of Milrinone indicate that it may be advantageous in facilitating weaning from cardiopulmonary bypass of these high-risk patients have been reported, but none in children
OBJECTIVES: To determine the efficacy of milrinone bolus prior to weaning from CPB among children in NYHA Class III-IV undergoing mitral valve surgery through echocardiographic parameters. Specific objectives are: (1) to determine mean change in LV ejection fraction and cardiac output between treatment and placebo groups from baseline and at 30 mins, 12 hours, and 24 hours postoperatively; and (2) to compare the treatment and placebo groups in terms of intraoperative parameters (ischemic time, bypass time) and postoperative course (mean hospital stay, duration of inotropic and ventilatory support
SUBJECTS AND METHODS: This is a double-blind placebo-controlled study involving all children with ages 6-18 years of age undergoing mitral valve surgery from January-October 1999. Patients were randomized and given either milrinone at 50 ug/kg/min loading dose over 20 minutes followed by continuous infusion of 0.5 ug/kg/min, or matching placebo 15 minutes prior to withdrawal of cardiopulmonary bypass. Echocardiographic parameters for LV function (LV ejection, fractional shortening, LVEDD, cardiac output) are then noted preoperatively and at 30 minutes, 12 hours, and 24 hours postoperatively
RESULTS: A total of sixteen patients were included during the duration of the study, all of which were in NYHA Class IV, with a mean age of 15 years. There was a significant increase in LV ejection fraction and cardiac index in the Milrinone groups as early as the immediate post-op period (30 minutes) compared with the placebo (p value 0.05). Cardiac output likewise increased in both groups but was highly significant at p0.001 in the milrinone group. There was a considerable decrease in bypass time and ventilatory support in the milrinone group but did not reach statistical significance. Significant decrease in mean hospital stay (20 days) in the milrinone subset compared with the placebo (42 days) is f significant note
CONCLUSION: Milrinone bolus at 50 ug/kg loading dose prior to CPB weaning followed by continuous infusion at 0.5 ug/kg/min among children in NYHA Class IV undergoing mitral valve surgery significantly improves LV function immediately after surgery till 24-hours post-op. There is likewise a decrease in ischemic time and duration of inotropic support and mean hospital stay. (Author)##

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Philippine Heart Center Journal
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