Alpha blocker and angiotensin-converting enzyme inhibitor in the management of severe pulmonary valve stenosis: from bench to bedside
| Autor: | Mohammed Omar Galal, Muhammad Ali Khan |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Balloon Valvuloplasty
Male medicine.medical_specialty Captopril Heart Ventricles Medizin Angiotensin-Converting Enzyme Inhibitors Heart Septal Defects Atrial Phentolamine Internal medicine medicine Humans Adrenergic alpha-Antagonists Retrospective Studies biology business.industry Infant Newborn Disease Management Infant Angiotensin-converting enzyme General Medicine medicine.disease Oxygen Pulmonary Valve Stenosis medicine.anatomical_structure Ventricle Pediatrics Perinatology and Child Health Pulmonary valve stenosis Balloon dilation Cardiology Patent foramen ovale biology.protein Female Alpha blocker Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Cardiology in the Young. 25:1306-1310 |
| ISSN: | 1467-1107 1047-9511 |
| Popis: | IntroductionNeonates with severe pulmonary valve stenosis tend to remain oxygen dependent, despite resolution of the transpulmonary gradient. Alpha 2 blockers – phentolamine – and angiotensin-converting enzyme inhibitors – captopril – were reported to improve oxygen saturation.ObjectiveTo describe the role of phentolamine and captopril in the treatment of these patients.MethodsIn a retrospective cohort study, 28 neonates with severe pulmonary valve stenosis underwent balloon valvuloplasty. Among them, 20 remained oxygen or prostaglandin dependent after intervention, and were treated with phentolamine or captopril. Oxygen saturation was monitored before and after intervention and following treatment with these medications. Mean duration of hospitalisation was recorded.ResultsMean age and weight were 25.2 days and 3.1 kg, respectively. Before balloon dilation, 18/20 (90%) neonates were on prostaglandin, whereas after the procedure only 6/18 patients required it. All 20 patients required oxygen after the procedure, and nine patients (45%) were started on phentolamine. Among them, one patient with severe infundibular stenosis did not respond favourably, and 11 patients (55%) were started on captopril. After starting phentolamine or captopril treatment, prostaglandin could be discontinued after a mean time of 15.86 hours. Within ConclusionPhentolamine and captopril seem to have therapeutic roles in neonates with severe pulmonary valve stenosis who remain oxygen dependent after balloon dilation. Both drugs led to vasodilation of the pulmonary and systemic vascularisation and facilitated inflow to the right ventricle. Right-to-left shunt across a patent foramen ovale or atrial septal defect decreased and saturation improved, leading to a significant reduction in the length of hospitalisation. |
| Databáze: | OpenAIRE |
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