Intravenous Enalaprilat and Oral Enalapril in Congestive Heart Failure Secondary to Ventricular Septal Defect in Infancy Thierry Sluysmans, MD, Madeleine Styns-Cailteux, MD, Micheline Tremouroux-Wattiez, MD, Paul Andre de Lame, MD, Jean Lintermans, PhD, Jean Rubay, MD, and Andre Vliers, PhD uccessful management of congestive heart failure (CHF) in infants with a left-toright shunt is difficult S and medical therapy with digoxin and a diuretic drug is not always of sufficient benefit.1-3The magnitude of the shunt through a ventricular septal defect (VSD) is responsiveto changesin systemic resistance,as shown in animals4 and in infants after using hydralazine as an afterload-reducing agent.5-7The use of angiotensin-convetting enzymeinhibitors for CHF of adults is well estab lished,Sand clinical studies in infants with left-to-right shunt and CHF suggesta beneficial effect9 Few hemodynamic data are available. We assessed the acute hemodynamic effects of enalaprilat given intravenously and the clinical benefits of oral enalapril in infants with a large VSD. Eight infants, each with an isolated large VSD were studied (2 girls, 6 boys, age 45 beatslmin, liver >2 cm below the costal margin, weight