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Angiotensin-converting enzyme inhibitors in pediatric patients with mitral valve regurgitation-case-control study and review of the literature.
Congenit Heart Dis. 2010 May-Jun; 5(3):278-84.CH

Abstract

OBJECTIVES

To investigate the effectiveness of chronic administration of angiotensin-converting enzyme inhibitors in pediatric patients with mitral valve regurgitation.

DESIGN, SETTING, PATIENTS, INTERVENTIONS

This was a case-control study of all echocardiograms of patients with moderate-to-severe mitral valve regurgitation, who underwent chronic administration of angiotensin-converting enzyme inhibitors between January 1990 and December 2006 at a single center.

OUTCOME MEASURES

Echocardiographic parameters (left ventricular end-diastolic diameter, left ventricular posterior wall diameter, interventricular septum diameter, left atrium to aortic root diameter ratio, grade of mitral valve regurgitation, shortening fraction) were analyzed before and during therapy with angiotensin-converting enzyme inhibitors in 12 patients and compared with 12 patients without medications after one month and one year.

RESULTS

Twenty-four consecutive pediatric patients (median age of 7 years with a range 1 month-16 years) with moderate-to-severe mitral valve regurgitation were included. Data are given as standard deviation scores (z-scores) derived from body-surface-adjusted normal values. During angiotensin-converting enzyme inhibition left ventricular end-diastolic diameter decreased from mean z-score 2.04 to 1.66 (after 1 month) and to 1.73 (after 1 year), while left ventricular posterior wall diameter decreased from 0.25 to 0.12 (after 1 year), respectively. Shortening fraction, interventricular septum diameter, grade of mitral valve regurgitation, and left atrium to aortic root diameter ratio remained stable.

CONCLUSIONS

In this case-control study of patients with moderate-to-severe mitral valve regurgitation effectiveness of angiotensin-converting enzyme inhibition on left ventricular dimensions and function after 1 month and 1 year is limited. Reviewing the literature, the lack of long-term follow-up studies with large patient cohorts and controversial study-results in adults require a prospective long-term multicenter follow-up study in pediatric patients.

Authors+Show Affiliations

Division of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland. walter.knirsch@kispi.uzh.chNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

20576047

Citation

Knirsch, Walter, et al. "Angiotensin-converting Enzyme Inhibitors in Pediatric Patients With Mitral Valve Regurgitation-case-control Study and Review of the Literature." Congenital Heart Disease, vol. 5, no. 3, 2010, pp. 278-84.
Knirsch W, Tlach L, Stambach D, et al. Angiotensin-converting enzyme inhibitors in pediatric patients with mitral valve regurgitation-case-control study and review of the literature. Congenit Heart Dis. 2010;5(3):278-84.
Knirsch, W., Tlach, L., Stambach, D., & Bauersfeld, U. (2010). Angiotensin-converting enzyme inhibitors in pediatric patients with mitral valve regurgitation-case-control study and review of the literature. Congenital Heart Disease, 5(3), 278-84. https://doi.org/10.1111/j.1747-0803.2010.00407.x
Knirsch W, et al. Angiotensin-converting Enzyme Inhibitors in Pediatric Patients With Mitral Valve Regurgitation-case-control Study and Review of the Literature. Congenit Heart Dis. 2010 May-Jun;5(3):278-84. PubMed PMID: 20576047.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Angiotensin-converting enzyme inhibitors in pediatric patients with mitral valve regurgitation-case-control study and review of the literature. AU - Knirsch,Walter, AU - Tlach,Lucie, AU - Stambach,Dominik, AU - Bauersfeld,Urs, PY - 2010/6/26/entrez PY - 2010/6/26/pubmed PY - 2010/10/13/medline SP - 278 EP - 84 JF - Congenital heart disease JO - Congenit Heart Dis VL - 5 IS - 3 N2 - OBJECTIVES: To investigate the effectiveness of chronic administration of angiotensin-converting enzyme inhibitors in pediatric patients with mitral valve regurgitation. DESIGN, SETTING, PATIENTS, INTERVENTIONS: This was a case-control study of all echocardiograms of patients with moderate-to-severe mitral valve regurgitation, who underwent chronic administration of angiotensin-converting enzyme inhibitors between January 1990 and December 2006 at a single center. OUTCOME MEASURES: Echocardiographic parameters (left ventricular end-diastolic diameter, left ventricular posterior wall diameter, interventricular septum diameter, left atrium to aortic root diameter ratio, grade of mitral valve regurgitation, shortening fraction) were analyzed before and during therapy with angiotensin-converting enzyme inhibitors in 12 patients and compared with 12 patients without medications after one month and one year. RESULTS: Twenty-four consecutive pediatric patients (median age of 7 years with a range 1 month-16 years) with moderate-to-severe mitral valve regurgitation were included. Data are given as standard deviation scores (z-scores) derived from body-surface-adjusted normal values. During angiotensin-converting enzyme inhibition left ventricular end-diastolic diameter decreased from mean z-score 2.04 to 1.66 (after 1 month) and to 1.73 (after 1 year), while left ventricular posterior wall diameter decreased from 0.25 to 0.12 (after 1 year), respectively. Shortening fraction, interventricular septum diameter, grade of mitral valve regurgitation, and left atrium to aortic root diameter ratio remained stable. CONCLUSIONS: In this case-control study of patients with moderate-to-severe mitral valve regurgitation effectiveness of angiotensin-converting enzyme inhibition on left ventricular dimensions and function after 1 month and 1 year is limited. Reviewing the literature, the lack of long-term follow-up studies with large patient cohorts and controversial study-results in adults require a prospective long-term multicenter follow-up study in pediatric patients. SN - 1747-0803 UR - https://www.unboundmedicine.com/medline/citation/20576047/Angiotensin_converting_enzyme_inhibitors_in_pediatric_patients_with_mitral_valve_regurgitation_case_control_study_and_review_of_the_literature_ L2 - https://doi.org/10.1111/j.1747-0803.2010.00407.x DB - PRIME DP - Unbound Medicine ER -