Effects of Carvedilol for Heart Failure in Patients with Functionally Univentricular Heart

  • Dr Naoko Ishibashi, Department of Pediatrics and Cardiovascular Surgery Sakakibara Heart Institute, Japan
  • Dr In-Sam Park, Department of Pediatrics and Cardiovascular Surgery Sakakibara Heart Institute, Japan
  • Dr Tadashi Waragai, Department of Pediatrics and Cardiovascular Surgery Sakakibara Heart Institute, Japan
  • Dr Tadahiro Yoshikawa, Department of Pediatrics and Cardiovascular Surgery Sakakibara Heart Institute, Japan
  • Dr Mitsunori Nishiyama, Department of Pediatrics and Cardiovascular Surgery Sakakibara Heart Institute, Japan
  • Dr Yasuo Murakami, Department of Pediatrics and Cardiovascular Surgery Sakakibara Heart Institute, Japan
  • Dr Makoto Ando, Department of Pediatrics and Cardiovascular Surgery Sakakibara Heart Institute, Japan
  • Dr Yukihiro Takahashi, Department of Pediatrics and Cardiovascular Surgery Sakakibara Heart Institute, Japan

    • Objective: Our purpose was to evaluate the clinical effects of carvedilol for heart failure in patients with functionally univentricular heart.
    Methods:Between 2002 and 2008, we used carvedilol in treating patients with functionally univentricular heart exhibiting heart failure(n=51).We classified them into three groups according to the status of each patient including status post Fontan operation(F),status post bidirectional Glenn(G), and those undergoing neither Glenn nor Fontan(NF). We compared clinical parameters before and after implementing carvedilol therapy. The parameters included cardiothoratic ratio(CTR),ventricular end-diastolic pressure(EDP),central venous pressure(CVP),ventricular ejection fraction(EF),serum brain natriuretic peptide level(BNP), and dosages of diuretics. We also investigated the New York Heart Association(NYHA) classification,degree of artrioventricular valvular regurgitation(AVVR), and presence of arrhythmia.
    Results: Carvedilol therapy was started at the mean age of 10.1 y(range, 1 m to 34.8 y). The initial dose was 0.04(range, 0.01 to 0.18)mg/kg/day and the maximum dose was 0.42(range, 0.01 to 0.92)mg/kg/day.The main reason for starting carvedilol was heart failure associated with ventricular contractile dysfunction(n=35),pleural effusion(n=11),ascites(n=1),arrhythmia(n=10),AVVR(n=11),protein-losing enteropathy(n=1) and frequent hospitalization(n=3).The patients were on diuretics(furosemide, hydrochlorothiazide or spironolactone; n=43),enalapril(n=34), pimopendan(n=9),digoxin(n=19) and losartan potassium(n=1). The CTR improved significantly from 59 to 46%(p<0.01), and the dosage of diuretic reduced significantly(p<0.01). The EF also significant improved in all patients(from 35 to 40%;p<0.05). This improvement was especially prominent in the Fontan group(from 35 to 45%;p<0.05).Clinical signs,symptoms and NYHA classes were also improved.
    Conclusions: We think that carvedilol might play an important role in treating heart failure associated with functionally univentricular heart.