Levosimendan is an inodilator agent belonging to the family of calcium sensitizer agents. Its positive inotropic and vasodilating properties make it interesting for the treatment of heart failure. Although this inotropic drug is increasingly used in children, a special license is still needed to obtain it in several countries.

To report our experience of levosimendan and to analyse its effects in children.

It was a single-centre retrospective study. From January 2010 to December 2014, all paediatric patients who received at least one perfusion of levosimendan were included. Levosimendan was administered as continuous infusions at a dose of 0.2µg/kg/min for 24 hours without any loading dose. Medical records were analyzed for each patient.

More than 200 patients received levosimendan during the period and more than 300 infusions were performed. No side effect was reported. Levosimendan significantly improved BNP level. Indications of levosimendan infusion were: 1) treatment of postoperative hemodynamic deterioration, 2) preoperative conditioning, 3) treatment of acute heart failure (myocardial ischemia, myocarditis, decompensated cardiomyopathies), 4) treatment of chronic heart failure (cardiomyopathies and failing Fontan).

Because of the long half-life of its active metabolite, levosimendan has a prolonged effect lasting for up to 7 to 9 days after discontinuation of a 24-hour infusion. Using this drug, the potential of arrhythmia is reduced as total intracellular calcium levels are not raised. This inodilator agent is safe and effective for the treatment of heart failure in children and must be part of the conventional therapeutic arsenal.