Captopril in Children With Cardiomyopathies

In this issue of Circulation, Bengur et all report their studies of the acute effects of captopril on the hemodynamics of children with congestive and restrictive cardiomyopathies. Captopril and other orally effective angiotensin converting enzyme (ACE) inhibitors have been studied in several large trials in adults with congestive heart failure,2-4 but relatively little has been published about the effects of these agents in children, especially those with primary myocardial diseases. In pediatric populations, the overwhelming majority of patients with the symptom complex of congestive heart failure have a congenital cardiac defect rather than a cardiomyopathy as the underlying cause of their symptoms. It is not surprising, therefore, that earlier pediatric studies of afterload reducing agents, including ACE inhibitors, have largely been done in patients with heart defects, primarily left-to-right shunt lesions. These studies have shown encouraging improvements in hemodynamics and symptoms in some affected children,5-7 but the ultimate therapy in most children with a heart defect is surgical correction of the defect, not long-term medical management. In