Pharmacotherapy of Heart Failure in Infants with Congenital Heart Disease

Every second patient who died from congenital heart disease is an infant with heart failure. However, infants were de facto excluded from the US Carvedilol trial and PANORAMA HF trial (Sacubitril/Valsartan), probably of cause their high mortality. Despite the negative results of the US Enalapril trial in infants with single ventricle, ACE inhibitors are further recommended in the guidelines. Propranolol is the only proven drug with clinical and neurohormonal benefits in 2 prospective randomized trials but was not recommended in the guidelines.

The review shows that pediatric cardiologists were unwilling to abandon the cardiocirculatory heart failure model in the last 30 years, thus depriving their patients of the benefits of the neurohumoral and early life stress heart failure models.

We are now able to monitor non-invasively heart rate variability, blood pressure and oxygen saturation in infants with heart failure in an outpatient setting. We visualize cardiac decompensation in an infant with complete atrioventricular septal defect after enalapril treatment and the benefits of betablocker therapy.

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The authors declare no conflict of interest.

Not applicable

The datasets used in this study are openly available at [repository link] and the source code is available on GitHub at [GitHub link].

This work did not receive any external funding.