Efficacy and safety of thermal vasodilation therapy by sauna in infants with severe congestive heart failure secondary to ventricular septal defect

Abstract

In isolated ventricular septal defect (VSD), surgical repair provides excellent results with a low mortality rate. However, the operative risk may be higher in infants, given the neurologic consequences of circulatory arrest.1,2 In addition, the risk of hepatitis from blood transfusion for cardioplasia bypass still exists.3 The hemodynamic improvement produced by vasodilators such as angiotensin-converting enzyme inhibitors provides great therapeutic benefit to adult and pediatric patients with congestive heart failure (CHF).4–7 The use of vasodilators in infants with CHF, particularly when caused by a large left-to-right shunt that results from a VSD, is controversial.6,7 The symptoms of CHF caused by pulmonary circulatory congestion in these infants sometimes worsens despite use of the vasodilator; the vasodilator may cause an excessive decline in pulmonary vascular resistance and an increase in left-to-right shunt volume. It has recently been reported that thermal vasodilation improved acute hemodynamics in adult patients with CHF.8–11 Sauna bathing is believed to be a better method of body warming, because it can be applied without increased external hydrostatic pressure and increases venous return during heat exposure.8–11 We assessed the efficacy and safety of thermal vasodilation therapy by far-infrared ray dry sauna in infants with severe CHF caused by VSD.