Vasopressin in Young Patients with Congenital Heart Defects for Postoperative Vasodilatory Shock

Lee, Chang Ha; Hwang, You Ju; Ahn, Young Chan; Jeon, Yang Bin; Lee, Jae Woong; Park, Chul Hyun; Park, Kook Yang; Han, Mi Young

Abstract

BACKGROUND: Vasodilatory shock after cardiac surgery may result from the vasopressin deficiency following cardiopulmonary bypass and sepsis, which did not respond to usual intravenous inotropes. In contrast to the adult patients, the effectiveness of vasopressin for vasodilatory shock in children has not been known well and so we reviewed our experience of vasopressin therapy in the small babies with a cardiac disease. MATERIAL AND METHOD: Between February and August 2003, intravenous vasopressin was administrated in 6 patients for vasodilatory shock despite being supported on intravenous inotropes after cardiac surgery. Median age at operation was 25 days old (ranges; 2~41 days) and median body weight was 2,870 grams (ranges; 900~3,530 grams). Preoperative diagnoses were complete transposition of the great arteries in 2 patients, hypoplastic left heart syndrome in 1, Fallot type double-outlet right ventricle in 1, aortic coarctation with severe atrioventricular valve regurgitation in 1, and total anomalous pulmonary venous return in 1. Total repair and palliative repair were undertaken in each 3 patient. RESULT: Most patients showed vasodilatory shock not responding to the inotropes and required the vasopressin therapy within 24 hours after cardiac surgery and its readministration for septic shock. The dosing range for vasopressin was 0.0002~0.008 unit/kg/minute with a median total time of its administration of 59 hours (ranges; 26~140 hours). Systolic blood pressure before, 1 hour, and 6 hours after its administration were 42.7+/-7.4 mmHg, 53.7+/-11.4 mmHg, and 56.3+/-13.4 mmHg, respectively, which shows a significant increase in systolic blood pressure (systolic pressure 1hour and 6 hours after the administration compared to before the administration; p=0.042 in all). Inotropic indexes before, 6 hour, and 12 hours after its administration were 32.3+/-7.2, 21.0+/-8.4, and 21.2+/-8.9, respectively, which reveals a significant decrease in inotropic index (inotropic indexes 6 hour and 12 hours after the administration compared to before the administration; p=0.027 in all). Significant metabolic acidosis and decreased urine output related to systemic hypoperfusion were not found after vasopressin administration.
CONCLUSION
In young children suffering from vasodilatory shock not responding to common inotropes despite normal ventricular contractility, intravenous vasopressin reveals to be an effective vasoconstrictor to increase systolic blood pressure and to mitigate the complications related to higher doses of inotropes.