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

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.