Hyperaldosteronism Complicating Congestive Heart Failure Due to a Left to Right Shunt in a Premature Infant

Congestive heart failure (CHF) due to left to right cardiac shunts is usually managed medically with diuretics and angiotensin converting enzyme inhibitors (ACEI) as after load reducing agents. We report a 31-week gestation premature male infant who did not respond to such treatment and was found to have hyperaldosteronism and severe hypokalemia, which was resistant to IV Potassium Chloride (KCL) infusion. The addition of spironolactone (an aldosterone antagonist) had a dramatic effect within 2 days as CHF symptoms improved clinically and both aldosterone and serum potassium levels normalized. Also, NTproBNP was found to be a useful biochemical marker for CHF that correlated well with the clinical picture.