[Oral enalapril in patients with symptomatic ventricular septal defects]

Experimental and clinical studies have demonstrated that the inhibitors of angiotensin-converting enzyme may reduce the left-to-right shunt over a ventricular septal defect (VSD). The objective of the study is to evaluate the effects of enalapril on short and medium follow-up in patients with symptomatic VSD and Qp/Qs ratio > 1.5 and compare the results with conventional anti-congestive treatment in children. Twenty-four patients with ages from 3 months to 8 years were studied, dividing them in 3 groups of 8 patients each. Group I received treatment with enalapril, group II with furosemide an digoxin, and group III was treated with a combination of the three medicaments. Patients were evaluated after one, three and six months. Evaluation considered clinical signs of congestive failure, weight, heart rate, blood pressure, cardiothoracic index, and with echocardiography the dimensions of the cardiac chambers, size of the VSD and hemodynamic parameters as Qp/Qs, pulmonary artery pressure (PAP), systolic pressure gradient over the VSD, EF and SF. Statistic analysis was done for each group and was compared the three groups. The results demonstrated significant weight gain (p > 0.05) in the three groups. A decrease in heart rate, Qp/Qs and PAP was observed in group III, however without statistic significance. No side effects were observed. The use of enalapril in combination with furosemide and digoxin may have beneficial effects in patients with symptomatic VSD, awaiting surgery.