Right Ventricle: Wrong Targets? Another Blow for Pharmacotherapy in Congenital Heart Diseases
Pharmacotherapeutic algorithms developed to treat heart failure in adults with acquired heart disease have often provided the template for treatment of ventricular dysfunction or heart failure symptoms in patients with underlying congenital heart disease. Superficially at least, this is not completely irrational, as 'congenital' patients often demonstrate similar levels of functional incapacity and a neurohomonal profile similar to that seen in 'acquired heart failure'1. Scratch beneath the surface however, and the situation is much less clear. Systolic failure as the primary manifestation and driver of disease progression is rather rare, fundamentally the circulation in these patients is often quite different, and the rate of functional decline and adverse events tends to be substantially lower than that observed in the major studies of beta blockade and modifiers of the rennin-angiotensin system in acquired heart failure. Consequently there is an ever-increasing catalog of, albeit small, randomized controlled trials that have failed to show a significant clinical benefit of these therapies in congenital heart disease2-6. The study by van der Bom and colleagues, examining the role of valsartan in patients with a systemic right ventricle (RV) and published in this issue of Circulation7 can now be added to that list.
- angiotensin converting enzyme inhibitors
- congenital heart disease
- transposition of great vessels
- Received December 11, 2012.
- Accepted December 12, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited