Related Experiment Videos
Short-term hemodynamic effects of captopril in infants with congestive heart failure
R E Shaddy1, D F Teitel, C Brett
1Department of Pediatrics, University of California, San Francisco.
Insights
Captopril effectively reduced the pulmonary-to-systemic blood flow ratio in infants with congestive heart failure and elevated systemic vascular resistance. Renal function monitoring is crucial during treatment.
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Hemodynamics
Background:
- Congestive heart failure in infants often results from large left-to-right shunts.
- Standard treatments like digoxin and diuretics may be insufficient for refractory cases.
Purpose of the Study:
- To evaluate the short-term hemodynamic effects of captopril in infants with congestive heart failure.
- To determine captopril's impact on pulmonary-to-systemic blood flow ratio based on baseline systemic vascular resistance.
Main Methods:
- Ten infants with congestive heart failure and large left-to-right shunts received captopril (0.5-1.0 mg/kg) via nasogastric tube during cardiac catheterization.
- Hemodynamic parameters, including systemic blood flow, pulmonary blood flow, and the pulmonary-to-systemic blood flow ratio, were measured.
- Patients were stratified based on baseline systemic vascular resistance (<20 U/m² vs. >20 U/m²).
Main Results:
- Overall, captopril did not significantly alter mean systemic blood flow, pulmonary blood flow, or the pulmonary-to-systemic blood flow ratio for the entire group.
- In infants with baseline systemic vascular resistance >20 U/m², captopril decreased the pulmonary-to-systemic blood flow ratio.
- Conversely, in infants with baseline systemic vascular resistance <20 U/m², captopril increased this ratio.
Conclusions:
- Captopril acutely decreases the pulmonary-to-systemic blood flow ratio in infants with large left-to-right shunts and elevated systemic vascular resistance.
- Close monitoring of renal function is essential when administering captopril to this population.
Abstract:
We studied the short-term hemodynamic effects of captopril in ten infants with congestive heart failure secondary to large left-to-right shunts who were refractory to routine medical management with digoxin and diuretics. During cardiac catheterization, captopril (0.5 to 1.0 mg/kg) was administered by nasogastric tube. For the entire group, mean systemic blood flow, pulmonary blood flow, and the pulmonary-to-systemic blood flow ratio did not change significantly after captopril administration. However, in the seven patients in whom baseline systemic vascular resistance was greater than 20 U/m2, captopril decreased the pulmonary-to-systemic blood flow ratio. In contrast, in the three patients in whom baseline systemic vascular resistance was less than 20 U/m2, captopril increased the pulmonary-to-systemic blood flow ratio. We conclude that captopril acutely decreases the pulmonary-to-systemic blood flow ratio in infants with large left-to-right shunts who have elevated systemic vascular resistance. Renal function must be monitored closely when using captopril.