Skip to main content

Advertisement

SpringerLink
Log in

Acute hemodynamic effects of converting enzyme inhibition in children with intracardiac shunts

  • Original Articles
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Summary

The short-term hemodynamic effects of intravenous enalaprilat were assessed in 26 infants and children, aged 6 months to 15 years, with intracardiac shunts undergoing cardiac catheterization. Pulmonary and systemic pressure, flow, and resistance indices were measured by the direct Fick method before and 30 min after enalaprilat at 0.06 mg/kg.

Aortic and pulmonary artery pressure decreased 15 and 20%, respectively, by 10 min, with little further change at 30 min. The heart rate did not change significantly and there was no reduction in systemic flow. In those with a large ventricular septal defect and normal or near-normal pulmonary resistance (<3.5 u.m2,n=8), the mean pulmonary-systemic flow ratio decreased from 2.9±0.3 to 2.4±0.3 (p<0.05) and the mean left-to-right shunt from 7.4±0.8 to 5.9±0.7 L/min/m2 (p<0.02). Those with an elevated pulmonary vascular resistance (>5 u.m2,n=8) showed a varied response. Two children, both with Down's syndrome, an atrioventricular canal defect, and reversible pulmonary hypertension (as assessed by an infusion of isoproterenol), had no decrease in pulmonary vascular resistance with enalaprilat. There were no adverse effects.

Converting enzyme inhibitors may benefit “heart failure” associated with large ventricular septal defects and normal or mildy elevated pulmonary resistance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Artman M, Parrish MD, Boerth RC, Roucek RJ, Graham TP (1984) Short-term hemodynamic effects of hydralazine in infants with complete atrioventricular canal defects.Circulation 69:949–954

    Google Scholar 

  2. Beekman RH, Rocchini AP, Dick M, Crowley DC, Rosenthal A (1984) Vasodilator therapy in children: acute and chronic effects in children with left ventricular dysfunction or mitral regurgitation.Pediatrics 73:43–51

    Google Scholar 

  3. Beekman RH, Rocchini AP, Rosenthal A (1981) Hemodynamic effects of nitroprusside in infants with a large ventricular septal defect.Circulation 64:553–558

    Google Scholar 

  4. Beekman RH, Rocchini AP, Rosenthal A (1982) Hemodynamic effects of hydralazine in infants with a large ventricular septal defect.Circulation 65:523–528

    Google Scholar 

  5. Berman W, Yabek SM, Dillon T, Niland C, Corlew S, Christensen D (1983) Effects of digoxin in infants with a congested circulatory state due to a ventricular septal defect.N Engl J Med 308:363–366

    Google Scholar 

  6. Boucek MM, Chang RL (1988) Effects of captopril on the distribution of left ventricular ouput with ventricular septal defect.Pediatr Res 24:499–503

    Google Scholar 

  7. Boucek MM, Chang R, Synhorst DP (1985) Hemodynamic consequences of inotropic support with digoxin or amrinone in lambs with ventricular septal defect.Pediatr Res 19:887–891

    Google Scholar 

  8. Boucek MM, Chang R, Synhorst DP (1989) Renin-angiotensin II response to the hemodynamic pathology of ovines with ventricular septal defect.Circ Res 64:524–531

    Google Scholar 

  9. Collins G, Calder L, Rose V, Kidd L, Keith J (1972) Ventricular septal defect: clinical and hemodynamic changes in the first five years of life.Am Heart J 84:695–705

    Google Scholar 

  10. CONSENSUS Trial Study Group (1987) Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS).N Engl J Med 316:1429–1435

    Google Scholar 

  11. DeMarco T, Daly PA, Liu M, Kayser S, Parmley WM, Chatterjee K (1987) Enalaprilat, a new parenteral angiotensin-converting enzyme inhibitor: rapid changes in systemic and coronary hemodynamics and humoral profile in chronic heart failure.J Am Coll Cardiol 9:1131–1138

    Google Scholar 

  12. Dickstein K, Aarsland T, Tjelta K, Cirillo VJ, Gomez HJ (1987) A comparison of hypotensive responses after oral and intravenous administration of enalapril and lisinopril in chronic heart failure.J Cardiovasc Pharmacol 9:705–710

    Google Scholar 

  13. Dzau VJ, Colucci WS, Williams GH, Curfman G, Meggs L, Hollenberg NK (1980) Sustained effectiveness of converting enzyme inhibition in patients with severe congestive heart failure.N Engl J Med 302:1373–1379

    Google Scholar 

  14. Escudero J, Navarro J, Padua A, Betancourt L, Nava G (1987) Hemodynamic changes with enalapril in pulmonary arterial hypertension secondary to congenital heart disease.Chest 91:351–355

    Google Scholar 

  15. Fisher DR, Faulkner SL, Sell CG, Graham TP Bender HW (1978) Operative closure of isolated defects of the ventricular septum: planned delay.Ann Thorac Surg 26:351–356

    Google Scholar 

  16. Frenneaux M, Stewart RAH, Newman CMH, Hallidie-Smith KA (1989) Enalapril for severe heart failure in infancy.Arch Dis Child 64:219–223

    Google Scholar 

  17. Grossman W (1986) Clinical measurement of vascular resistance and assessment of vasodilator drugs. In: Grossman W (ed)Cardiac catheterization and angiography. Lea and Febiger, Philadelphia, pp 135–142

    Google Scholar 

  18. Hoffman JIE, Rudolph AM (1965) The natural history of ventricular septal defects in infancy.Am J Cardiol 16:634–653

    Google Scholar 

  19. Hornung RS, Hillis WS (1987) The acute haemodynamic effects of intravenous enalaprilic acid (MK422) in patients with left ventricular dysfunction.Br J Clin Pharmacol 23:29–33

    Google Scholar 

  20. Kubo SH, Cody RJ, Laragh JH, et al (1985) Immediate converting-enzyme inhibition with intravenous enalapril in chronic congestive heart failure.Am J Cardiol 55:122–126

    Google Scholar 

  21. Leier CV, Bambach D, Nelson S, Hermiller JB, Huss P, Magorien RD, Unverferth DV (1983) Captopril in primary pulmonary hypertension.Circulation 67:155–161

    Google Scholar 

  22. Lister G, Hoffman JIE, Rudolph AM (1974) Oxygen uptake in infants and children: a simple method for measurement.Pediatrics 53:656–662

    Google Scholar 

  23. Lloyd TR, Mahoney LT, Knoedel D, Marvin WJ, Robillard JE, Lauer RM (1989) Orally administered enalapril for infants with congestive heart failure: a dose-finding study.J Pediatr 114:650–654

    Google Scholar 

  24. Montigny M, Davignon A, Fouron JC, Biron P, Fournier A, Elie R (1989) Captopril in infants for congestive heart failure secondary to a large ventricular left-to-right shunt.Am J Cardiol 63:631–633

    Google Scholar 

  25. Nakazawa M, Takao A, Chon Y, Shimizu T, Kanaya M, Momma K (1983) Significance of systemic vascular resistance in determining the hemodynamic effects of hydralazine on large ventricular septal defects.Circulation 68:420–424

    Google Scholar 

  26. Nakazawa M, Takao A, Shimizu T, Chon Y (1983) Afterload reduction treatment for large ventricular septal defects: dependence of haemodynamic effects of hydralazine on pretreatment systemic blood flow.Br Heart J 49:461–465

    Google Scholar 

  27. Neutze JM, Ishikawa T, Clarkson PM, Calder AL, Barratt-Boyes BG, Kerr AR (1989) Assessment and follow-up of patients with ventricular septal defect and elevated pulmonary vascular resistance.Am J Cardiol 63:327–331

    Google Scholar 

  28. Packer M, Medina N, Yushak M (1984) Efficacy of captopril in low-renin congestive heart failure: importance of sustained reactive hyperreninemia in distinguishing responders from non-responders.Am J Cardiol 54:771–777

    Google Scholar 

  29. Scammell AM, Arnold R, Wilkinson JL (1987) Captopril in treatment of infant heart failure: a preliminary report.Int J Cardiol 16:295–301

    Google Scholar 

  30. Shaddy RE, Teitel DF, Brett C (1988) Short-term hemodynamic effects of captopril in infants with congestive heart failure.Am J Dis Child 142:100–105

    Google Scholar 

  31. Sharpe DN, Murphy J, Coxon R, Hannan SF (1984) Enalapril in patients with chronic heart failure: a placebo-controlled, randomized, double-blind study.Circulation 70:271–278

    Google Scholar 

  32. Shaw NJ, Wilson N, Dickinson DF (1988) Captopril in heart failure secondary to a left to right shunt.Arch Dis Child 63:360–363

    Google Scholar 

  33. Synhorst DP, Lauer RM, Doty DB, Brody MJ (1976) Hemodynamic effects of vasodilator agents in dogs with experimental ventricular septal defects.Circulation 54:472–477

    Google Scholar 

  34. Webster MWI, Fitzpatrick MA, Nicholls MG, Ikram H, Wells JE (1985) Effect of enalapril on ventricular arrhythmias in congestive heart failure.Am J Cardiol 56:566–569

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology Department, Green Lane Hospital, Green Lane West, 3, Auckland, New Zealand

    M. W. I. Webster, J. M. Neutze & A. L. Calder

Authors
  1. M. W. I. Webster
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. M. Neutze
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. L. Calder
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Webster, M.W.I., Neutze, J.M. & Calder, A.L. Acute hemodynamic effects of converting enzyme inhibition in children with intracardiac shunts. Pediatr Cardiol 13, 129–135 (1992). https://doi.org/10.1007/BF00793943

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00793943

Key Words

Search

Navigation