Abstract
Amrinone (AM) is an orally active inotropic agent that is both a systemic and a pulmonary vasodilator. We used intravenous AM to treat life-threatening pulmonary hypertension (PH) in 4 neonates (NEO), 12 to 36 hrs old, in whom right to left ductal shunting indicated severe PH; and in 5 children (CH), 6 mo. to 12 yrs old, whose mean pulmonary artery pressure (PAP)≥ mean aortic pressure (AoP). These patients were unresponsive to hyperventilation and conventional pharmacologic therapy of their PH.
All NEO had persistant fetal circulation (PFC), either idiopathic or 2°to a diaphragmatic hernia, and had severe cyanosis without heart failure. AM (1-3 mg/kg bolus) decreased AoP by 22% (+2% to −37%), and decreased arterial pO2 (−6 torr; range: +2 to −22 torr), possibly indicating a greater fall in AoP than in PAP.
Of the 5 CH, 4 had idiopathic PH, 1 had PH 2° to a previously closed VSD; all were acyanotic. A single dose of AM (1-3 mg/kg) had little effect on AoP (−3% to +3%) or PA wedge pressure (measured in 2 patients, ±1 mmHg), but it markedly decreased PAP in all CH (22% to 44%; mean = 27%, p<.01). However, in 3 of the 5 CH, little change in PAP occurred after a 2nd or 3rd dose of AM.
To summarize: In NEO with PFC, AM was not beneficial and may have somewhat increased cyanosis. In CH with PH, AM initially selectively decreased PAP but early tachyphylaxsis was seen in most children. This tachyphylaxsis may severely limit AM's role in the treatment of PH.
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Kulik, T., Johnson, D., Green, T. et al. AMRINONE FOR PULMONARY HYPERTENSION IN INFANTS AND CHILDREN. Pediatr Res 18 (Suppl 4), 125 (1984). https://doi.org/10.1203/00006450-198404001-00190
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DOI: https://doi.org/10.1203/00006450-198404001-00190
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