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Abstract
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.
