Use of Oral Droxidopa to Improve Arterial Pressure and Reduce Vasoactive Drug Requirements During Persistent Vasoplegic Syndrome After Cardiac Transplantation

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Case Presentation

A 53-year-old woman (100 kg, 170 cm) with end-stage nonischemic cardiomyopathy and bridge-to-transplant left ventricular assist device support (HeartWare, Framingham, MA) was transported to the operating room for orthotopic cardiac transplantation (the left ventricular ejection fraction of the donor heart was estimated to be 60%). The patient was treated chronically with oral amiodarone before surgery, but not an angiotensin-converting enzyme inhibitor. The patient’s initial intraoperative

Discussion

Droxidopa is a synthetic catecholamine-like amino acid that was first synthesized almost 100 years ago. The chemical structure of droxidopa is similar to another synthetic amino acid, the prototypical Parkinson’s disease medication L-3,4-dihydroxyphenylalanine (L-DOPA). Droxidopa has been available for clinical use in Japan since 1989.11 The US Food and Drug Administration recently approved droxidopa for the treatment of neurogenic orthostatic hypotension, and initial clinical trials

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