EFFICACY AND DOSAGE OF ENALAPRIL IN CONGENITAL AND ACQUIRED HEART-DISEASE

In a tertiary referral centre 63 patients underwent 67 treatment perio ds with enalapril. The median age was 5.4 months. All children had sig ns of heart failure: congestive cardiac failure with breathlessness at rest was present in 88%. Haemodynamic groups were left-to-right shunt (n=15), impaired ventricular function (n=14), after cardiac surgery ( n=23), valvar regurgitation (n=12), and hypertension (n=3). Serial cli nical, radiological, and laboratory data were used to judge outcome. T he mean (SD) maximal dose was 0.30 (0.21) mg/kg/day. Thirty nine (58%) patients improved, 20 (30%) showed no improvement, and eight (12%) ha d side effects requiring discontinuation of enalapril. Renal failure i n eight patients was related to young age, low weight, and left-to-rig ht shunt group. Three patients died in congestive heart failure with r enal failure. Enalapril was clinically safe and effective for children with cardiac failure secondary to ventricular impairment, valvar regu rgitation, or after cardiac surgery. Renal failure was a problem in yo ung infants with left-to-right shunts.