Hemodynamic assessment of Levosimendan use in a newborn with vein of Galen aneurismatic malformation

Objective. Vein of Galen aneurismatic malformation (VGAM) is a rare congenital anomaly which can be present during the neonatal period with high output heart failure. Medical management of VGAM-related hemodynamical status is complex and challenging.
The aim of this study was to gain reliable data about hemodynamic changes after Levosimendan use in one patient with VGAM.
Materials and Methods. Hemodynamic parameters indicative of cardiac preload, afterload, contractility and tissue oxygen delivery were systematically collected and analyzed offline before and after 48 hours from Levosimendan infusion.
MostCare-Up^® relies on pressure recording analytical method (PRAM) and analyses beat-by-beat arterial waveform.
Near-Infrared Spectroscopy (NIRS) measures regional cerebral and splanchnic tissue oxygen saturation (rSO₂c and rSO₂s).
Results. The female baby had a prenatal diagnosis of VGAM and was born preterm (33+2 GA) due to fetal heart failure. Postnatal heart failure was treated with continuous infusion of diuretics (etacrynic acid, up to 0.2 mg/kg/h), milrinon (0.75 mcg/kg/min) and Levosimendan at 8 hours of life after discontinuation of milrinon.
Use of Levosimendan determined significant changes in the hemodynamic status; we recorded significantly higher systolic, diastolic and dicrotic arterial pressure, higher Cardiac Index (CI) and a significant increase in DO₂I (total amount of oxygen delivered to the tissues per minute).
NIRS and rSO₂c/rSO₂s values were not significantly different before and after treatment protocol (Table 1).
Conclusions. This is the first case report exploring hemodynamic changes after Levosimendan treatment in a patient with VGAM.
We observed a significant improvement of arterial pressure values, CI and global oxygen delivery within 48 hours after treatment.