The role of angiotensin-converting enzyme inhibitors in the treatment of heart failure in children is much less clear. Angiotensin-converting enzyme inhibitors may have acute hemodynamic benefits in children with heart failure caused by large left-to-right shunts [Shaddy: 1988] [Montigny: 1989] [Lloyd: 1989] [Rheuban: 1990] and may also benefit children whose heart failure is caused by systemic ventricular systolic dysfunction. [Bengur: 1991] [Lewis: 1993] However, the only randomized, placebo-controlled trial of angiotensin-converting enzyme inhibitors in children with heart disease was in children with single ventricle physiology who had undergone the Fontan procedure. [Kouatli: 1997] In this study, no difference in exercise capacity between the 2 groups was found. This study was limited by the fact that these patients were not in heart failure and thus may not have been representative of children with heart failure symptoms.
At present, angiotensin-converting enzyme inhibitors are recommended for adults with left ventricular dysfunction with or without symptoms; they should be used with diuretics in patients with fluid retention and should be started at low doses and gradually increased as tolerated.
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