Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-18T21:31:08.788Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of enalapril on infants and children with congestive heart failure

Published online by Cambridge University Press:  19 August 2008

Masashi Seguchi ,
Makoto Nakazawa  and
Kazuo Momma
Masashi Seguchi*
Affiliation:
Department of Pediatric Cardiology, The Heart Institute of Japan, Tokyo Women‘s Medical College, Tokyo
Makoto Nakazawa
Affiliation:
Department of Pediatric Cardiology, The Heart Institute of Japan, Tokyo Women‘s Medical College, Tokyo
Kazuo Momma
Affiliation:
Department of Pediatric Cardiology, The Heart Institute of Japan, Tokyo Women‘s Medical College, Tokyo
*
Dr. Masashi Seguchi, Department of Pediatric Cardiology, The Heart Institute of Japan, Tokyo Women's Medical College, 8–1 Kawada cho, Shinjuku-ku, Tokyo, Japan 162
Get access Rights & Permissions [Opens in a new window]

Summary

The effect of enalapril, an inhibitor of angiotensin converting enzyme, was studied in 35 infants and children with congestive heart failure associated either with residual mitral or aortic regurgitation following intracardiac repair (24 patients) or with dilated cardiomyopathy (11 patients). Enalapril, at an average dose of 0.24 ±0.10 mg/kg, reduced the concentration of angiotensin II in the serum from 115 ± 67 pg/ml to 60 + 30 pg/ml and increased plasma renin activity from 25 + 24 ng/ml/hr to 45 ± 37 ng/ml/hr. There was a significant decrease in hepatomegaly, cardiothoracic ratio, heart rate and blood pressure in both groups of patients. Left ventricular end-diastolic dimension as evaluated by cross-sectional echocardiography, also decreased, whereas fractional shortening and systolic time intervals improved in both groups of patients. Adverse effects were noted in only one infant with postoperative mitral regurgitation who developed renal failure with oliguria, increase of blood urea nitrogen and serum creatinine. Renal function improved dramatically after discontinuation of enalapril. Hyperkalemia (>5mEq/ 1) was observed in four patients, three of whom were receiving spironolactone. Our results showed that enalapril is effective in improving hemodynamics in the relatively short-term treatment of infants and children with congestive heart failure due to postoperative volume overload or dilated cardiomyopathy. These conditions are poorly controlled with conventional medical therapy.

Keywords

ACE inhibitorenalaprilheart failure
Type
Original Articles
Information
Cardiology in the Young , Volume 2 , Issue 1 , January 1992 , pp. 14 - 19
Copyright
Copyright © Cambridge University Press 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Curtis, C, Cohn, JN, Urobal, T. Role of the renin angiotensin system in the systemic vasoconstriction of chronic heart failure. Circulation 1978; 58: 763–770.Google Scholar
2.Turni, GA, Brunner, HR, Ferguson, RK. Congestive heart failure in man. Hemodynamics, renin, and angiotensin II blockade. Br Heart j 1978; 40: 1134–1142.Google Scholar
3.Levine, TB, Franciosa, JA, Cohn, JN. Acute and long-term response to an oral converting-enzyme inhibitor, captopril, in congestive heart failure. Circulation 1980; 62: 35–41.CrossRefGoogle Scholar
4.Pfeffer, MA, Lamas, GA, Vaughan, EV. Effect of captopril on progressive ventricular dilation after anterior myocardial infarction. N Engl J Med 1988; 319: 80–86.CrossRefGoogle ScholarPubMed
5.Packer, M. Vasodilator and inotropic drugs for the treatment of chronic heart failure: Distinguishing hype from hope. J Am Coll Cardio! 1988; 12: 1299–1317.CrossRefGoogle ScholarPubMed
6.Amsterdam, EA. Angiotensin-converting enzyme inhibition for congestive heart failure: Achievements and potential. J Am Coll Cardiol 1989; 13: 143–144.Google Scholar
7.Friedman, WF, George, BL. Treatment of congestive heart failure by altering loading conditions of the heart. J Pediatr 1985; 106: 697–706.CrossRefGoogle ScholarPubMed
8.Artman, M, Graham, TP. Guidelines for vasodilator therapy of congestive heart failure in infants and children. Am Heart J 1987; 113: 994–1005.CrossRefGoogle ScholarPubMed
9.Shaddy, RE, Teitel, DF, Brett, C. Short-term hemodynamic effects of captopril in infants with congestive heart failure. Am J Dis Child 1988; 142: 100–105.Google Scholar
10.Shaw, NJ, Wilson, N, Dickinson, DF. Captopril in heart failure secondary to a left to right shunt. Arch Dis Child 1988; 63: 360–363.CrossRefGoogle ScholarPubMed
11.Montigny, M, Davignon, A, Fouron, JC, Biron, P, Fournier, A, Elie, R. Captopril in infants for congestive heart failure secondary to a large ventricular left-to-right shunt. Am J Cardiol 1989; 63: 631–633.CrossRefGoogle ScholarPubMed
12.Hichens, M, Hang, EL, Mulcahy, WS. Radioimmunoassay for angiotensin-converting enzyme. Ligand Quarterly 1981; 4: 43.Google Scholar
13.Sahn, DJ, DeMaria, A, Kisslo, J, Weyman, A. The committee on M-mode standardization of the American Society of Echocardiography: Recommendations regarding quantitation in M-mode echocardiography: Results of a survey of echocar-diographic measurements. Circulation 1978; 58: 1072–1083.CrossRefGoogle Scholar
14.Mason, DT. Afterload reduction and cardiac performance. Am J Med 1978; 65: 106–120.CrossRefGoogle ScholarPubMed
15.Chatterjee, K, De-Marco, T, Rouleau, JL. Vasodilator therapy in chronic congestive heart failure. Am J Cardiol 1988; 62: 46A–54A.CrossRefGoogle ScholarPubMed
16.Franciosa, JA, Wilson, MM, Jordan, RA. Effects of enalapril, a new angiotensin-converting enzyme inhibitor, in a controlled trial in heart failure. J Am Coll Cardiol 1985; 5: 101–107.CrossRefGoogle Scholar
17.The CONSENSUS trial group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 1987; 316: 1429–1435.Google Scholar
18.Boucek, MM, Chang, RL. Effects of captopril on the distribution of left ventricular output with ventricular septal defect. Pediatr Res; 24: 499–503.Google Scholar
19.Frenneaux, M, Stewart, RAH, Newman, CMH, Hallidie-Smith, KA. Enalapril for severe heart failure in infancy. Arch Dis Child 1989; 64: 219–223.CrossRefGoogle ScholarPubMed
20.Williams, GH. Converting-enzyme inhibitors in the treatment of hypertension. N Engl J Med 1988; 23: 1517–1525.Google Scholar
21.Lloyd, TR, Mahoney, LT, Knoedel, D. Oral administered enalapril for infants with congestive heart failure: A dosefinding study. J Pediatr 1989; 114: 650–654.CrossRefGoogle Scholar
22.Nakashima, M, Hashimoto, H, Ohguchi, S. Phase 1 trial of a single oral dose of MK-421, A new angiotensin I converting enzyme inhibitor, in healthy subjects -first report. Pharmacology and Therapy 1984; 12: 3357–3374. [Japanese]Google Scholar
23.Fleisch, JH. Age-related changes in the sensitivity of blood vessels to drugs. Pharmac Ther 1980; 8: 477–487.CrossRefGoogle ScholarPubMed
24.Gheorghiade, M, Hall, V, Lakier, JB, Goldstein, S. Comparative hemodynamic and neurohormonal effects of intravenous captopril and digoxin, and their combination in patients with severe heart failure. J Am Coll Cardiol 1989; 13: 134–142.CrossRefGoogle ScholarPubMed