3-Month Enalapril Treatment in Pediatric Fontan Patients With Moderate to Good Systolic Ventricular Function

Area of Science:

• Pediatric Cardiology
• Cardiovascular Pharmacology
• Congenital Heart Disease

Background:

• Many Fontan patients receive angiotensin-converting enzyme (ACE) inhibitors, but their effectiveness is uncertain.
• Pediatric Fontan patients with moderate-to-good systolic ventricular function are often treated with ACE inhibitors.

Purpose of the Study:

• To evaluate the short-term effects of enalapril on exercise capacity, vascular, and ventricular function in pediatric Fontan patients.
• To determine if enalapril improves outcomes in Fontan patients with preserved systolic function.

Main Methods:

• A 3-month enalapril treatment was given to 28 pediatric Fontan patients (8-18 years) with moderate-good systolic ventricular function.
• Evaluated exercise tests, echocardiography for ventricular function, arterial stiffness, and N-terminal pro-B-type natriuretic peptide levels before and after treatment.
• Dosage was titrated based on systolic blood pressure during the first two weeks.

Main Results:

• Enalapril treatment lowered systolic blood pressure and N-terminal pro-B-type natriuretic peptide levels.
• No significant improvements were observed in exercise capacity, ventricular function, or arterial stiffness.
• Adverse events, including significant drops in systolic blood pressure, occurred in 21% of patients.

Conclusions:

• Short-term angiotensin-converting enzyme (ACE) inhibition with enalapril offers no discernible benefit for exercise capacity or cardiac function in pediatric Fontan patients with moderate-to-good systolic ventricular function.
• The use of ACE inhibitors in this specific Fontan population warrants further investigation regarding long-term effects and specific indications.