Angiotensin Converting Enzyme Inhibition in Children With Mitral Regurgitation

Trial of ACE Inhibition in Children With Mitral Regurgitation After Repair of AVSD

This study will evaluate the efficacy and safety of angiotensin converting enzyme inhibition (ACE-I) therapy for the treatment of mitral regurgitation (MR).

BACKGROUND:

MR causes volume overload and hemodynamic burden on the left ventricle. Initial compensatory mechanisms may fail, leading to increased severity. Patients who have had repair of an atrioventricular septal defect (AVSD) are selected for this study as they have a relatively high incidence of moderate MR and their regurgitant orifice is mobile and dynamic, contributing to the likelihood that they might respond to medical therapy.

DESIGN NARRATIVE:

This is a randomized, double-blind, placebo-controlled trial of ACE-I therapy in children less than 18 years of age with at least moderate MR who are at least 6 months postoperative from repair of an AVSD. A non-randomized Observational Phase enrolled 181 children who were less than 6 months postoperative from repair of an AVSD, who were then evaluated at 6 months for trial eligibility.

Inclusion Criteria:

• Children less than 18 years of age and at least 6 months post AVSD repair or reoperation
• At least moderate MR
• Asymptomatic or minimally symptomatic, defined by Ross Heart Failure Class I or II
• Atrioventricular synchrony (paced or intrinsic)

Exclusion Criteria:

• Tetrology of Fallot, total or partial anomalous venous connection
• More than trivial MS or outflow obstruction
• Other sources of LV volume overload
• Hypertrophic obstructive cardiomyopathy
• Significant residual coarctation