Acute effects of the ACE inhibitor enalaprilat on the pulmonary, cerebral and systemic blood flow and resistance after the bidirectional cavopulmonary connection

Kyong Jin Lee, Shi Joon Yoo, Helen Holtby, Brian Grant, Dariusz Mroczek, Derek Wong, Lars Grosse-Wortmann, Leland N. Benson, Rajiv R. Chaturvedi

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Background: The bidirectional cavopulmonary connection (BCPC) is used in the staged palliation of univentricular hearts and places the cerebral and pulmonary vascular beds in series. Angiotensin-converting enzyme inhibitors (ACEI) are often used in this complex circulation, but the effects of their vasodilation are unclear. Objective: Assessment of the acute response of perfusion pressure, flow and resistance across the systemic, cerebral and pulmonary vascular beds to ACEI in patients with a BCPC. Design: Prospective interventional study. Setting: Single tertiary care centre. Patients: 12 patients with a BCPC (median age 28 months, weight 11.8 kg) undergoing a pre-Fontan catheterisation with MRI measurement of flows. Intervention: Intravenous enalaprilat 0.005 or 0.01 mg/kg. Results: Enalaprilat increased descending aorta flow (median 21.6%, p=0.0005), decreased total pulmonary vein flow (median 10.6%, p=0.025), and both superior caval vein flow (median 8.6%, p=0.065) and aortopulmonary collateral flow (median 15.5%, p=0.077) tended to decrease. Total cardiac output was unchanged (p=0.57). Systemic vascular resistance (median 41.9%, p=0.0005) and cerebral vascular resistance (median 23.4%, p=0.0005) decreased, but pulmonary vascular resistance (p=0.73) showed little change. There was evidence of autoregulation of cerebral blood flow. The proportion of descending aortic flow to total cardiac output increased (median 27 to 35%, p=0.001). Systemic oxygen saturation decreased from 87% to 83% (p=0.02). Conclusion: Enalaprilat did not increase total cardiac output but redistributed flow to the lower body, with a concomitant decrease in arterial oxygen saturation. It is difficult to increase cardiac output in patients with a BCPC and ACEI should be used with caution in those with borderline aortic saturations.

Original languageEnglish (US)
Pages (from-to)1343-1348
Number of pages6
JournalHeart
Volume97
Issue number16
DOIs
StatePublished - Aug 2011
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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