Phentolamine continuous infusion in a pediatric patient with uncontrolled hypertension

Abstract Purpose A case of uncontrolled hypertension nonresponsive to traditional pharmacologic management in a pediatric patient with a ventricular assist device awaiting a heart transplant is reported. Summary A 4-month-old male in heart failure was experiencing uncontrolled hypertension. Because of a lack of hemodynamic stability, he was unable to be listed as a heart transplant candidate. He received multiple antihypertensive agents (calcium channel blockers, β-blockers, and direct-acting vasodilators) as both intermittent and continuous infusions over the course of several days without achieving normotension. The decision was then made to administer intravenous phentolamine as a continuous infusion to pursue a different mechanism than with traditional antihypertensive agents to achieve hemodynamic stability. Within 8 hours of initiation of the continuous phentolamine infusion, the patient became normotensive and was listed for a heart transplant. The continuous phentolamine infusion was administered over the next 4 days to maintain normotension, and on day 4 the patient underwent successful orthotopic heart transplantation. Conclusion A 4-month-old male in heart failure with a ventricular assist device, experiencing uncontrolled hypertension nonresponsive to traditional pharmacologic management, was successfully treated with a continuous intravenous infusion of phentolamine.