[Hemodynamic effects of oral captopril in patients with critical aortic stenosis].
OBJECTIVE
To analyse the hemodynamic and ventricular function effects of oral captopril in severe aortic stenosis.


METHODS
inclusion criteria: patients older than 18 years with critical aortic stenosis.


METHODS
angiotensin-converting enzyme inhibitor used previously contraindication to right catheterisation aortic insufficiency, valvular prosthesis in aortic position, or other valvulopathy. As well as the need for immediate valvular aortic replacement arrhythmia, A-V conduction alterations, or ventilatory support.


METHODS
prospective, no randomized. Swan-Ganz catheter was used. Basal hemodynamic measurements were made on 1, 2, 4, 6 and 8 hours during 48 hours. Captopril was administered 12.5 mg first and then 8 mg tid (6 doses).


METHODS
Neuman-Keuls test was used for multivariate comparisons. Statistical significance was determined with P < 0.05.


RESULTS
22 patients were analyzed. Systemic vascular resistance fell from 1750 Dyn/seg/cm-5 to 1200 (P-0.001), cardiac output increased from 4.1l/min to 5.8 (P-0.001), cardiac index increased from 2.4 l/min/m2 to 2.9 (P-0.009), stroke volume from 47 ml to 64 (P-0.04) and stroke volume index from 27 ml/m2 to 36 (P-0.002). In patients with heart failure (n = 7) the systemic vascular resistance fell from 2050 Dyn/seg/cm-5 to 1463 (P-0.04), cardiac output increased from 2.8l/min to 4.1 (P-0.04), cardiac index from 2.07 l/min/m2 to 2.75 (P-0.04), stroke volume from 46 ml to 64 (P-0.03), pulmonary capillary wedge pressure fell from 19 mmHg to 16 (0.04) and the systolic pulmonary arterial pressure fell from 63 mmHg to 42 (P-0.009).


CONCLUSIONS
captopril improves the hemodynamic parameters in patients with critical aortic stenosis, principally in those with heart failure.
Martínez Sánchez
C
C
Instituto Nacional de Cardiología Ignacio Chávez. (INCICH. Juan Badiano No.1, 14080, México, D.F.).
Henne
O
O
Arceo
A
A
Peña
M
M
González
H
H
Chuquiure
E
E
Lupi
E
E
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D002216:Captopril / Q000008:administration & dosage / Q000494:pharmacology*; D018592:Cross-Over Studies; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects*
D000806:Angiotensin-Converting Enzyme Inhibitors; D002216:Captopril