Effects of Phosphodiesterase-3 Inhibitor in the Management of Left Heart Failure in Extremely Low-Birth-Weight Infants with Simple Aortic Coarctation.

Abstract

We herein present a case of simple aortic coarctation (CoA) after ductus arteriosus ligation, in which the combination of a phosphodiesterase-3 (PDE3) inhibitor with liposomal prostaglandin E1 (lipoPGE1) improved the pressure gradient between the upper and lower limbs and enhanced left ventricular function. A female infant was born at 29 weeks 1 day of gestation as the smaller twin in a monochorionic diamniotic pregnancy, with a birth weight of 744 g (-3.0 SD). She was diagnosed with simple CoA at 2 days of age and treated with lipoPGE1. However, because of progressive congestive heart failure, patent ductus arteriosus ligation was performed at 9 days of age. By 21 days of age, the pressure gradient between her upper and lower limbs worsened to 55 mmHg despite continued lipoPGE1 treatment. At that point, the PDE3 inhibitor olprinone was introduced in combination with lipoPGE1. After starting the combination therapy, the pressure gradient decreased to 24 mmHg while the blood pressure in the lower extremities remained similar, and the left ventricular function improved. The PDE3 inhibitor may have contributed to improving the stenosis of the CoA site. Further studies are needed to clarify the efficacy of this treatment.