Clinical case of using epleronon and candesartan for correction of heart failure in patients with Ebshtein’s anomaly

Abstract

Aim. To evaluate the efficacy of eplerenone and candesartan in heart failure correction in a patient with Ebstein's anomaly detected in adulthood.

Methods. A clinical case of long-term follow-up of a patient with a rare pathology, Ebstein's anomaly detected in adulthood, is described. The data of subjective examination are given. The anomaly was identified during a screening heart ultrasound exam, the patient had no complaints before, and had no history of chronic diseases, including congenital heart defects among family members. Also, the patient underwent routine diagnostic methods — general clinical studies, cardiac echocardiography, magnetic resonance imaging of the heart, N-terminal pro-brain natriuretic peptide measurement. In addition, the effect of correcting the signs of heart failure with a combination of candesartan and eplerenone in the complex treatment of heart failure according to echocardiography data and the level of N-terminal pro-brain natriuretic peptide is shown.

Results. A decrease in the level of N-terminal pro-brain natriuretic peptide, an increase of the ejection fraction according to echocardiography with the use of eplerenone and candesartan in the complex treatment of heart failure in these patients were demonstrated.

Conclusion. Despite the limited data on the use of antagonists of mineralcorticoid receptors and angiotensin receptor blockers among the patients with Ebstein's anomaly, the clinical case presented in the article demonstrates high effectiveness of this combination in treating heart failure in such patients.

Keywords

Ebstein's anomaly / heart failure / eplerenone / candesartan / ejection fraction / N-terminal pro-brain natriuretic peptide

References

[1] Waldmann V., Khairy P. Ventricular arrhythmias and sudden death in patients with Ebstein anomaly: insights from a retrospective cohort study. J. Thorac. Dis. 2018; 10 (Suppl. 18): S2172–S2175. DOI: 10.21037/jtd.2018.06.74.

[2] Sharma N., Lalnunnem T.J., Nandwani M. et al. Ebstein anomaly with pregnancy: A rare case. J. Reprod. Infertil. 2018; 19 (2): 119–122. PMID: 30009147.

[3] Malhotra A., Agrawal V., Patel K. et al. Ebstein's anomaly: “The One and a Half Ventricle Heart”. Braz. J. Cardiovasc. Surg. 2018; 33 (4): 353–361. DOI: 10.21470/­1678-9741-2018-0100.

[4] Ministry of Healthcare of the Russian Federation. Klinicheskie rekomendatsii. Ano­maliya Ehbshteyna. (Clinical guidelines. Ebstein’s anomaly.) 2017. https://racvs.ru/clinic/files/2017/anomalia_Ebsteina.pdf (access date: 14.06.2019). (In Russ.)

[5] Министерство здравоохранения Российской Федерации. Клинические рекомендации. Аномалия Эбштейна. 2017. https://racvs.ru/clinic/files/2017/anomalia_Ebsteina.pdf (дата обращения: 14.06.2019).

[6] Singh D.P., Mahajan K. Ebstein anomaly and malformation. Treasure Island (FL): StatPearls Publishing. 2019. https://www.ncbi.nlm.nih.gov/books/NBK534824/ (access date: 14.06.2019).

[7] Sprin­dzhuk M.V., Adzerikho I.E., Dergachev A.V. Ebstein’s anomaly. Novosti khirurgii. 2007; 15 (4), 112–122. GURNPTS “Kardiologiya”, Belarusʹ. (In Russ.)

[8] Спринджук М.В., Адзерихо И.Э., Дергачёв А.В. Аномалия Эбштейна. Новости хирургии. 2007; 15 (4), 112–122. ГУРНПЦ «Кардиология», Беларусь.

[9] Bin Li, Han-Song Sun, Shi-Wei Pan, Jian-Ping Xu. Outcomes of Ebstein’s anomaly patients treated with tricuspid valvuloplasty of tricuspid valve replacement: Expe­rience of a single center. Chin. Med. J. (Engl.). 2018; 131 (9): 1067–1074. DOI: 10.4103/0366-6999.230731.

[10] Beroukhim R.S., Jing L., Harrild D.M. et al. Impact of the cone operation on left ventricular size, function, and dyssynchrony in Ebstein anomaly: a cardiovascular magnetic resonance study. J. Cardiovasc. Magn. Reson. 2018; 20: 32. DOI: 10.1186/s12968-018-0452-0.

[11] Dan Yang, Xiao Li, Jia-Yu Sun et al. Cardiovascular magnetic resonance evidence of myocardial fibrosis and its clinical significance in adolescent and adult patients with Ebstein’s anomaly J. Cardiovasc. Magn. Reson. 2018; 20: 69. DOI: 10.1186/s12968-018-0488-1.

[12] Acharya P., Ang J.R., Gitler B. Ebstein ano­maly with QRS fragmentation on electrocardiogram. J. Investig. Med. High Impact. Case Rep. 2017; 5 (1): 2324709616688710. DOI: 10.1177/2324709616688710.

[13] Danilenko O.A., Belokhvostik D.I., Rako­vich A.E., Tatusʹ Ya.S. Full review of Ebstein’s anomaly: etiology, clinical presentation, treatment. Molodoy uchenyy. 2018; (14): 110–112. (In Russ.)

[14] Даниленко О.А., Белохвостик Д.И., Ракович А.Э., Татусь Я.С. Полный обзор аномалии Эбштейна: этиология, клиника, лечение. Молодой учёный. 2018; (14): ­110–112.

[15] Crepin D., Jimenez M., Thambo J.B. et al. Facteurspredictifs de mortalitedans la maladied’Ebstein. Arch. Mal. Coeur. Vaiss. 2004; 97 (5): 535–539.

[16] Kudeyarova T.V., Duruda N.V., Bublikov D.S. et al. Anomaliya Ehbshteyna. Klinicheskiy sluchay. Sovremennye problemy nauki i obrazovaniya. 2017; (6). https://www.science-education.ru/ru/article/view?id=27294 (access date: 15.06.2019). (In Russ.)

[17] Кудеярова Т.В., Дуруда Н.В., Бубликов Д.С. и др. Аномалия Эбштейна. Клинический случай. Соврем. пробл. науки и образования. 2017; (6). https://www.science-education.ru/ru/article/view?id=27294 (дата обращения: 15.06.2019). DOI: 10.17513/spno.27294.

RIGHTS & PERMISSIONS

Bublikov D.S., Duruda N.V., Kudeyarova T.V., Klester E.B., Pinaeva A.S., Турчина A.M.