Preoperative levosimendan inhalation in a patient with mitral regurgitation and severe pulmonary hypertension

Levosimendan is a common inodilator for heart failure management. However, intravenous administration of this drug is associated with side effects (decreased systemic vascular resistance) that leads to systemic hypotension and need for vasopressors. Inhalation of levosimendan prevents side effects of intravenous administration and selectively affects right ventricular contractility and pulmonary vessels. The authors used inhalation of levosimendan in an 83-year-old patient with post-infarction mitral insufficiency and severe pulmonary hypertension before cardiac surgery. To evaluate the effectiveness of this method, the authors used vector analysis and assessed intraventricular blood flows in cardiac chambers using modern capabilities of echocardiography. There was a significant improvement of right ventricular contractility, pulmonary artery pressure and myocardial energy reserves before surgery without catecholamines.