Early experience with Levosimendan in children with ventricular dysfunction

Pediatr Crit Care Med. 2006 Sep;7(5):445-8. doi: 10.1097/01.PCC.0000235251.14491.75.


Objective: To describe our preliminary experience with Levosimendan, a new calcium-sensitizing agent in critically unwell infants and children with severe heart failure.

Design: Retrospective cohort analysis.

Setting: Pediatric intensive care unit.

Patients: Fifteen children aged 7 days to 18 yrs (median age 38 months) with severe myocardial dysfunction secondary to end-stage heart failure, or acute heart failure, who were inotrope-dependent (requiring at least one catecholamine).

Interventions: A single dose (bolus and intravenous infusion over 24-48 hrs) of Levosimendan was given under continuous hemodynamic monitoring in our intensive care unit. Eleven children received a single dose, three children received two doses, and one child received four doses. Echocardiographic assessments of ventricular function were made before and 3-5 days after Levosimendan infusion.

Measurements and main results: Heart rate, systolic pressure, diastolic pressure, mean blood pressure, and central venous pressure were unchanged during and after Levosimendan. Levosimendan allowed for discontinuation of catecholamines in ten patients and a dose reduction in three. The dose of dobutamine was reduced from 6.4 microg/kg/min pre-Levosimendan to 1.8 microg/kg/min on day 5 (p < .01). Ejection fraction for the group as a whole improved from 29.8% to 40.5% (p = .015); this did not increase significantly in patients with end-stage heart failure but increased by 63% in the children with acute heart failure.

Conclusions: Levosimendan can be safely administered to infants and children with severe heart failure. Levosimendan allowed for substantial reduction in catecholamine infusions in children with end-stage or acute heart failure and also produced an objective improvement in myocardial performance in children with acute heart failure.

MeSH terms

  • Adolescent
  • Cardiac Output, Low / drug therapy*
  • Cardiotonic Agents / therapeutic use*
  • Catecholamines / therapeutic use
  • Child
  • Child, Preschool
  • Cohort Studies
  • Critical Illness
  • Humans
  • Hydrazones / therapeutic use*
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Pediatric
  • Pyridazines / therapeutic use*
  • Retrospective Studies
  • Simendan
  • Stroke Volume / drug effects
  • Ultrasonography
  • Ventricular Dysfunction / diagnostic imaging
  • Ventricular Dysfunction / drug therapy*


  • Cardiotonic Agents
  • Catecholamines
  • Hydrazones
  • Pyridazines
  • Simendan