Left right shunt congenital heart disease with digoxin treatment of heart failure evaluation of the effectiveness of serum NT-PRO BNP level

INTRODUCTIONWe aimed to evaluate the effectiveness of two different drug combinations (digoxin-furosemide-enalapril and furosemide-enalapril) on the treatment of heart failure in the children with congenital heart defect with left to right shunt.MATERIALS AND METHODSThe study took place in Inonu University Faculty of Medicine, Department of Pediatric Cardiology, between 2010 and 2011. Children with heart failure secondary to left to right shunt congenital heart diseases were selected. Group 1 patients were treated with digoxin, enalapril, and furosemide; group 2 patients were treated with enalapril and furosemide. The ages ranged between 10 days and 24 months in 37 patients (group-1 and group-2) and 20 healthy children (group-3, control group). After physical examination all children were evaluated with Ross clasification. All children were examined with echocardiography. Plasma NT-proBNP level and complete blood count were evaluated in all children. The heart failure decisions were made according to findings of physical examination and echocardiography. 19 Patients were in group 1, 18 patients were in group 2. At the end of the four weeks of treatment all patients were evaluated again.RESULTSGroup 1 consisted of 6 (31.6%) female and 13 (68.4%) male; Group 2, 10 (55.6%) female and 8 (44%) male, and group 3 9 (45.0%) female and 11 (55.0%) mail patients. The age of patients was 3.7 ± 4.4 months in Group 1, 3.4 ± 3.5 months in group 2, and 5 ± 3.7 months in group 3. There was no difference between group 1, group 2 and control group for age and sex. Sex and age had no effect on NT-proBNP levels in control group. Pretreatment levels of NT-proBNP were high in patient groups and there was no statistically significant difference between them. The posttreatment levels of NT-proBNP were decreased and there was also no difference between two levels. Decline in NT-proBNP levels was not different between the groups (p = 0.372).CONCLUSIONThe effectiveness of two different drug combinations (digoxin, furosemide, enalapril and enalapril, furosemide) was not different in the treatment of heart failure secondary to left to right shunt heart diseaseses. Both treatments were found effective, and the use of digoxin supplied no additional benefit.Keywords: Left-to-right shunt, congenital heart disease, heart failure, NT-proBNP, children, treatment