What is a normal ejection fraction for a four year old boy?

My grandson had an echocardiogram, ekg, and chest xray and was evaluated by a pediatric cardiologist. The reason for this is because both his mother and maternal aunt (my daughters) had dilated cardiomyopathy and cardiac transplants. My grandson is showing no symptoms of heart failure. He weighs 37 lbs and is eating normally. His activity level seems normal. The cardiologist said his ejection fraction is 56% based on this echocardiogram. His last echocardiogram was in January 2009 and at that time his EF was 53%. The doctor is now saying that his left heart appears to be a little enlarged (but the same as in the Jan. echo) and that his EF should be at least 60% to be considered normal. He has prescribed 1 mg of enalapril daily and wants to do another echocardiogram in two months. I am concerned about giving him the enalapril because of side effects. I also am wondering how accurate the echocardiogram is in determining ejection fraction. I am thinking of getting a second opinion before giving him the medication. Can you give me any advice?

[EchoTech]

I am not a doctor.  

The pediatric cardiologists that I work with usually use the fraction shortening as a measurement of left ventricular function.  It is calculated slightly different than the Ejection Fraction.  In adults 55% and above is considered normal.  The enaparil will help his function if it is indeed in a reduced state.  Are you concerned about possible side effects or is he actually having side effects? Some people tolerate them better than others.   As far as the echocardiogram, it is the gold standard for assessing heart function in pediatrics.  As far as going for a second opinion, I don't think that your cardiologist is really that far out of line.  It seems like a pretty reasonable course of action to me, but I'm not a doctor either.
   Another point is that the cardiomyopathy can strike at any time, especially with what appears to be your family's propensity towards the disease.  That means for the next ten years it might be normal and then boom, he'll have problems.  It could be thirty years, no one can tell.  It is important to not get complacent with his follow ups.  I hope this helps you a little bit.

Good luck.