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Int J Cardiol. 2016 May 1;210:95-9. doi: 10.1016/j.ijcard.2016.02.089. Epub 2016 Feb 18.

Use of ACE inhibitors in Fontan: Rational or irrational?

Author information

1
Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Victoria, Australia.
2
The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia; Department of Paediatrics, University of Sydney, Sydney, Australia.
3
Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Cardiology, Royal Children's Hospital, Melbourne, Australia.
4
Department of Cardiology, Women's and Children's Hospital, Adelaide, Australia.
5
Greenlane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand.
6
Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia.
7
Queensland Paediatric Cardiac Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
8
Adult Congenital Heart Unit, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Victoria, Australia.
9
Children's Cardiac Centre, Princess Margaret Hospital for Children, Perth, Australia.
10
Department of Paediatrics, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
11
Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
12
Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Victoria, Australia. Electronic address: yves.dudekem@rch.org.au.

Abstract

BACKGROUND:

Despite a lack of evidence supporting the use of angiotensin-converting enzyme (ACE) inhibitors in patients with a Fontan circulation, their use is frequent. We decided to identify the rationale for ACE inhibitor therapy in patients within the Australia and New Zealand Fontan Registry.

METHODS:

All patients in the Registry taking an ACE inhibitor at last follow up were identified, and a review of medical records was undertaken to determine the rationale for treatment initiation and reasons for treatment continuation or dose increase.

RESULTS:

In 2015, 36% of the surviving patients in the Registry (462/1268) were taking an ACE inhibitor. Indications for initiation of therapy were ventricular systolic or diastolic dysfunction (29%), atrioventricular valve regurgitation (19%), preservation of normal ventricular function (7%), prolonged effusions at Fontan (6%), hypertension (6%), other (6%) and unknown (2%). No indication was stated in the remaining patients (25%). Those with hypoplastic left heart syndrome were more likely to be on an ACE inhibitor than those with an alternative primary morphology (70% vs 32%; p<0.001). Only 36% of the patients treated with an ACE inhibitor at last follow up (166/462) had an indication that would generally justify treatment in a two-ventricle circulation.

CONCLUSION:

It is likely that the use of ACE inhibitors in patients with a Fontan circulation is excessive within our region. The coordination of prospective, multicentre studies and initiatives such as the Australia and New Zealand Fontan Registry will facilitate further investigations to guide treatment decisions in the growing Fontan population.

KEYWORDS:

Angiotensin-converting enzyme inhibitors; Fontan procedure; Heart defects congenital; Heart single ventricle; Heart ventricles abnormalities

PMID:
26938683
DOI:
10.1016/j.ijcard.2016.02.089
[Indexed for MEDLINE]
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