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3 results

  • Effect of anti-heart failure therapy on diastolic function in children with single-ventricle circulations

  • Deane L.S. Yim, Bryn O. Jones, Peta M.A. Alexander, Yves d’Udekem, Michael M.H. Cheung
  • Journal:
    Cardiology in the Young / Volume 25 / Issue 7 / October 2015
    Published online by Cambridge University Press:
    05 March 2015, pp. 1293-1299
  • Background

    Children with functionally univentricular circulations have chronic volume loading of the systemic ventricle, potentially affecting ventricular function. Medications including angiotensin-converting enzyme inhibitors and β-blockers are used to treat ventricular dysfunction, despite limited evidence of their efficacy in this population.

    Objective

    To determine the effects of angiotensin-converting enzyme inhibitors on elevated filling pressures in children with single ventricle physiology.

    Methods

    We performed a single-centre, retrospective review of patients with single ventricle physiology who underwent multiple cardiac catheterisations between 1991 and 2013. Study population comprised of patients who commenced or had optimised dosing of angiotensin-converting enzyme inhibitors between assessments in response to high ventricular filling pressures. Patients undergoing interventions influencing loading conditions between assessments were excluded.

    Results

    A total of 17 patients were identified, with dominant morphologic right ventricle in eight patients (47.1%). Among them, 11 (64.7%) were pre-Fontan and six (35.3%) were post-Fontan completion. Median inter-assessment interval was 9.4 months (range 7.3–19.1). There was a reduction in end-diastolic pressure from 13 to 10 mmHg (p=0.002), mean pulmonary artery pressure from 16 to 13 mmHg (p=0.049), and mean atrial pressure from 12 to 9 mmHg (p=0.001). There was one cardiac transplant, and there were no patient deaths at median follow-up after 31 months.

    Conclusions

    We observed a reduction in ventricular end-diastolic pressure, pulmonary artery pressure, and mean atrial pressure following treatment with angiotensin-converting enzyme inhibitors in patients with single ventricle physiology. Our study provides insights into the potential impact of anti-heart failure therapy in single ventricle circulations and calls for larger, controlled studies to assess for a therapeutic response.

  • 42 - Esophageal perforation and mediastinitis

  • from Section 6 - Gastrointestinal emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 278-283

  • Summary

    This chapter discusses the diagnosis, evaluation and management of upper airway emergencies. It presents special circumstances with regard to foreign bodies in the airway. The first step in the evaluation of the patient with suspected upper airway emergency is to determine the need for emergent intubation or surgical airway. If possible, a brief history should be obtained focusing on history of cancer, allergies, exposure to medications including ACE inhibitors, family history of C1 esterase inhibitor deficiency, trauma, and recent surgery. A targeted physical examination should include assessment for stridor, hoarseness, urticaria, edema of skin, lips, mouth, and throat. Given the high-risk, time-sensitive nature of these presentations, all practitioners should be familiar with their local resources, algorithms, and airway management options prior to seeing patients. In patients with a rapidly evolving upper airway obstruction, awake evaluation can provide invaluable information about potential complications before paralytics are administered.

  • Effect of enalapril on infants and children with congestive heart failure

  • Masashi Seguchi, Makoto Nakazawa, Kazuo Momma
  • Journal:
    Cardiology in the Young / Volume 2 / Issue 1 / January 1992
    Published online by Cambridge University Press:
    19 August 2008, pp. 14-19

  • The effect of enalapril, an inhibitor of angiotensin converting enzyme, was studied in 35 infants and children with congestive heart failure associated either with residual mitral or aortic regurgitation following intracardiac repair (24 patients) or with dilated cardiomyopathy (11 patients). Enalapril, at an average dose of 0.24 ±0.10 mg/kg, reduced the concentration of angiotensin II in the serum from 115 ± 67 pg/ml to 60 + 30 pg/ml and increased plasma renin activity from 25 + 24 ng/ml/hr to 45 ± 37 ng/ml/hr. There was a significant decrease in hepatomegaly, cardiothoracic ratio, heart rate and blood pressure in both groups of patients. Left ventricular end-diastolic dimension as evaluated by cross-sectional echocardiography, also decreased, whereas fractional shortening and systolic time intervals improved in both groups of patients. Adverse effects were noted in only one infant with postoperative mitral regurgitation who developed renal failure with oliguria, increase of blood urea nitrogen and serum creatinine. Renal function improved dramatically after discontinuation of enalapril. Hyperkalemia (>5mEq/ 1) was observed in four patients, three of whom were receiving spironolactone. Our results showed that enalapril is effective in improving hemodynamics in the relatively short-term treatment of infants and children with congestive heart failure due to postoperative volume overload or dilated cardiomyopathy. These conditions are poorly controlled with conventional medical therapy.