Effect Of ACEI On Pulmonary Hypertension In Children With The Left To Right Shunt Congenital Heart Disease

Objective1. To investigate the Influence of ACEI on cardiacfunction about the left to right shunt congenital heart disease in children.2.Toexplore the role of ACEI on the pulmonary hypertension and provide a theoreti-cal basis whether ACEI can have a preventive effect on the formationof pulmonary hypertension. Methods1. The left to right shunt congenital heartdiseases in children diagnosed in paediatrics of affiliated hospital of LuzhouMedical College were included in this study, except for pulmonary arterial hy-pertension formation, heart failure, non left to right shunt heart malforma-tions, natural healing tendency of small ventricular septal defect and congeni-tal heart disease in neonatus.2. Children were randomized to the treatmentgroup and the control group. The treatment group was given oral Captopril(0.5-1mg/kg, Q12h,8weeks), and the control group was given oral vitamin C（0.1,Q12h，8weeks）as placebo.3. Serum BNP, MMP-2, MMP-9andTIMP-1were assayed by using ELISA at four time points, and PASP, LVEF, theQp/Qs, Tei index were measured by cardiac color Doppler ultrasound. Results1. Serum level of BNP, MMP-2and MMP-9in the control group significantlyincreased and the serum level of TIMP-1reduced; after ACEI treatment, se-rum level of BNP, MMP-2and MMP-9significantly reduced（P<0.01） andserum level of TIMP-1increased.2. Tie indexes of the same ages in the control group significantly decreased at three time points, but Tei indexes significantlychange in the treatment group（P<0.01）.3. After the treatment, PASPwas significantly lower than the control group at the three time points （P<0.01）.4. And LVEF in the treatment group was significantly increasedat three time points, and it has statistical significance（P<0.01）.5. TheQp/Qs was gradually decreased in the treatment group and it has statistical sig-nificance(P<0.01). Conclusions1. ACEI may reduce serum level of MMP-2,9in patients with the left to right shunt CHD, mitigate pulmonary hypertensionformation.2. ACEI may decrease serum level of BNP in patients with the leftto right shunt CHD, reduce PASP and Qp/Qs，and improve indexes of cardiacfunction such as LVEF and Tei indexes.