Every second patient who dies 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 due to their high mortality risk. Despite the negative results of the US Enalapril trial in infants with univentricular hearts, ACE inhibitors are further recommended in the guidelines. Propranolol is the only drug that has been successful in two prospective randomized trials but was not recommended in the guidelines. This review discusses the dif erences between myocardial heart failure and congestive circulatory failure in infants with congenital heart disease that do not benefit from vasodilators but from beta-blockers that significantly improve clinical symptoms, neurohormonal activation and heart rate variability. The case of a non-invasive monitoring of heart rate variability, blood pressure and oxygen saturation of an infant with Down syndrome and complete atrioventricular septal defect visualize cardiac decompensation after enalapril and the benefits of beta-blocker treatment.
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.