Hemodynamic and neurohormonal causes of a severe verapamil induced cardiac decompensation in a child after Mustard operation

Abstract

Case report about a 16 year old boy after Mustard operation of transposition of the great arteries, who developed severe "diuretic resistant", congestive heart failure in longtime follow up under a antiarrhythmic therapy with verapamil. if cardiac recompensation succeeded only after termination of verapamil therapy hemodynamic and neurohumoral causes of systemic and pulmonary congestion were evaluated. Increase of systemic (by 75%) and pulmonary (by 150%) vascular resistance as well as a fall of cardiac index from 3,0 to 1,8 l/min/m(2) after verapamil therapy were invasively measured. Unchanged ejection fractions and atrial pressures are evidence, that the negative inotropic effect of verapamil seems not to be the cause of cardiac decompensation. After exclusion of neurohumoral causes, the increase of capillary filtration pressure by vasodilatation seems to be the pathophysiological cause of venous congestion in this patient.