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[Use of converting angiotensin inhibitors in children. II. Personal experience with enalapril]
1Kliniki Kardiologii Dzieciecej, Slaskiej Akademii Medycznej w Katowicach.
Insights
Enalapril, an angiotensin-converting enzyme inhibitor, showed benefits in 82% of pediatric patients with heart conditions like cardiomyopathy and hypertension. Its use is particularly recommended after complex heart surgeries.
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Cardiovascular Medicine
Background:
- Congestive cardiomyopathy and congenital heart malformations pose significant risks in children.
- Arterial hypertension and life-threatening arrhythmias require effective therapeutic interventions in pediatric populations.
- Angiotensin-converting enzyme inhibitors (ACEIs) have emerged as crucial agents in managing pediatric cardiovascular diseases.
Purpose of the Study:
- To evaluate the efficacy and safety of enalapril in a diverse group of pediatric patients.
- To assess the impact of enalapril on circulatory insufficiency, arterial hypertension, and arrhythmias in children.
- To identify specific pediatric cardiovascular conditions where enalapril demonstrates maximal therapeutic benefit.
Main Methods:
- A cohort of 51 children (4 days to 18 years) received enalapril.
- Patients presented with conditions including congestive cardiomyopathy, post-operative congenital heart malformations, arterial hypertension, and arrhythmias.
- Treatment involved a mean enalapril dose of 0.21 mg/kg daily, with some cases combined with digitalis.
Main Results:
- Enalapril demonstrated a beneficial effect in 82% of pediatric patients.
- Significant improvements were observed in children with congestive cardiomyopathy and those post-Fontan operation for complex heart malformations.
- Enalapril was effective as a sole antihypertensive agent, and its combination with digitalis showed promise in cardiomyopathy cases. Only one instance of mild side effect (cough) was reported.
Conclusions:
- Enalapril is a highly effective and safe treatment for various pediatric cardiovascular conditions.
- The drug shows particular promise in children with complex congenital heart disease undergoing surgical repair (Fontan procedure) and those with congestive cardiomyopathy.
- Enalapril serves as a valuable monotherapy for pediatric arterial hypertension and a beneficial adjunct in other cardiovascular conditions.
Abstract:
Angiotensin convertase inhibitor (Enalapril) was used in 51 children aged 4 days up to 18 years (mean 4.3 +/- 5.5, years). As many as 27 subjects were newborns (4) and infants (23). The patients suffered from circulatory insufficiency due to congestive cardiomyopathy (13 cases). 6 treated subjects suffered from circulatory insufficiency due to congenital heart malformations before cardiac surgery and 22 after it (including complex malformations operated according to Fontan method). 10 children were treated because of arterial hypertension. 4 subjects suffered form life-threatening arrhythmias coexisting with circulatory insufficiency. (These subjects were already mentioned among the patients suffering from circulatory insufficiency). Enalapril (mainly as a drug named Benalapril) was used in the mean dose of 0.21 mg/kg of body mass daily. 4 patients (8%) died during treatment but their deaths can not be related to angiotensin convertase inhibitor therapy. In the other children (82%) the beneficial influence of angiotensin convertase inhibitor use was found (improvement in comparison with the state before convertase inhibitor introduction). In 10% of subjects enalapril did not show any significant therapeutic effect. According to authors' opinion enalapril use is exceptionally profitable in the subjects surgically treated for complex heart malformations (Fontan operation). The beneficial effect was also found in majority of children suffering from congestive cardiomyopathy. Convertase inhibitor was always successfully used as the unique antihypertensive drug in children suffering from arterial hypertension. In the other cases treatment was combined (mainly with digitalis). This combination seems to be exceptionally useful in children suffering from congestive cardiomyopathy. Only in 1 case unserious side effect was found (persistent cough).