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Angiotensin-converting enzyme inhibition and pre-superior cavopulmonary connection haemodynamics in infants with single-ventricle physiology

Published online by Cambridge University Press:  16 February 2021

Asim Al Balushi ,
Konstantin Averin ,
Daphne T. Hsu  and
Andrew S. Mackie Open the ORCID record for Andrew S. Mackie [Opens in a new window]
Asim Al Balushi
Affiliation:
Division of Cardiology, Stollery Children’s Hospital, Department of Pediatrics, University of Alberta, Edmonton, Canada
Konstantin Averin
Affiliation:
Division of Cardiology, Stollery Children’s Hospital, Department of Pediatrics, University of Alberta, Edmonton, Canada
Daphne T. Hsu
Affiliation:
The Children’s Hospital at Montefiore, Albert Einstein College of Medicine, New York, NY, USA
Andrew S. Mackie*
Affiliation:
Division of Cardiology, Stollery Children’s Hospital, Department of Pediatrics, University of Alberta, Edmonton, Canada Women and Children’s Health Research Institute, University of Alberta, Edmonton, Canada
*
Author for correspondence: Dr A. S. Mackie, Division of Cardiology, Stollery Children’s Hospital, Department of Pediatrics, 4C2 Walter Mackenzie Center, 8440-112th St. NW, Edmonton, AB T6G 2B7, Canada. Tel: +780 407 8361; Fax: +780 407 3954. E-mail: andrew.mackie@ualberta.ca
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Abstract

Introduction:

Preliminary animal and human data suggest that angiotensin-converting enzyme inhibition has a role in pulmonary vascular remodelling. We sought to assess the effect of ACEi versus placebo on pulmonary artery pressure and transpulmonary gradient amongst infants undergoing single-ventricle palliation.

Materials and methods:

Using the publicly available Pediatric Heart Network Infant Single-Ventricle trial dataset, we compared mean PA pressure at pre-superior cavopulmonary connection catheterisation (primary outcome), transpulmonary gradient, pulmonary-to-systemic flow ratio, and post-SCPC oxygen saturation (secondary outcomes) in infants receiving enalapril versus placebo.

Results:

A total of 179 infants underwent pre-SCPC catheterisation, of which 85 (47%) received enalapril. There was no difference between the enalapril and placebo group in the primary and the secondary outcomes. Mean PA pressure in the enalapril group was 13.1 ± 2.9 compared to 13.7 ± 3.4 mmHg in the placebo group. The transpulmonary gradient was 6.7 ± 2.5 versus 6.9 ± 3.2 mmHg in the enalapril and placebo groups, respectively. The pulmonary-to-systemic flow ratio was 1.1 ± 0.5 in the enalapril group versus 1.0 ± 0.5 in the placebo group and the post-SCPC saturation was 83.1 ± 5.0% in the enalapril group versus 82.2 ± 5.3% in the placebo group. In the pre-specified subgroup analyses comparing enalapril and placebo according to ventricular morphology and shunt type, there was no difference in the primary and secondary outcomes.

Conclusion:

ACEi did not impact mean pulmonary artery pressure or transpulmonary gradient amongst infants with single-ventricle physiology prior to SCPC palliation.

Keywords

Univentricular heartPulmonary vascular resistanceBidirectional cavopulmonary anastomosis
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 9 , September 2021 , pp. 1434 - 1438
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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