Results from a small study indicate that beta-blocker therapy may have potential to improve functional class in patients with a systemic right ventricle and a pacemaker.S3.17-2 Angiotensin- converting enzyme inhibitors and angiotensin-recep- tor blockers have also been assessed in small studies in specific ACHD populations in which no significant benefit on ventricular function or exercise capacity has Data from 1 small trial with a short follow-up interval in patients with a systemic right ventricle suggest that eplerenone may be associ- ated with reduced myocardial fibrosis, as assessed by Some pharmacological therapies affecting the pul- monary vasculature (eg, endothelin-receptor antago- nists and phosphodiesterase type-5 [PDE-5] inhibitors) Table 12. Specific Management Practices for Cyanotic CHD Recording clinical oxygen saturation at rest (>5 min) rather than immediately after effort (eg, walking into a clinic examination room). Meticulous intravenous care to avoid air or particulate matter, which may include use of air/particulate filters on all intravenous access lines, when feasible, and careful de-airing of all lines. Cerebral imaging for any new headache or neurologic sign to assess for possible cerebral abscess, hemorrhage, or stroke. Measurement of serum uric acid and treatment with allopurinol in a patient with a history of gout. Supplemental oxygen as needed for symptom relief but not to a target oxygen saturation level and not if there is no demonstrable symptomatic benefit. Avoidance of or cautious use of therapies that may reduce the patient s hypoxia-mediated drive to ventilation, such as narcotics or, in rare circumstances, excess supplemental oxygen.S3.16-22 Anesthesia by providers with expertise in anesthesia for patients with ACHD for any noncardiac surgery. Non-estrogen containing birth control for women of child-bearing potential (intrauterine device may be a preferred option). Avoidance of birth control entirely is not a safe, acceptable option. 