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Thorac Cardiovasc Surg 2005; 53: S129-S134
DOI: 10.1055/s-2004-830452
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© Georg Thieme Verlag KG Stuttgart · New York

Heart Failure in Pediatric Patients[*]

M. Hoch1 , H. Netz1
  • 1Department of Pediatric Cardiology and Intensive Care, Ludwig- Maximilians-University, Munich, Germany
Further Information

Publication History

Received September 30, 2004

Publication Date:
09 February 2005 (online)

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Abstract

Paradigms in understanding heart failure have changed as the knowledge of pathophysiology and its molecular basis has deepened. In the chronic compensated state of heart failure recent research has focussed on the body's regulatory mechanisms. Today heart failure is understood as a complex interplay of hemodynamic and neurohormonal factors. In pediatrics a large variety of heterogeneous conditions cause heart failure. Some require special therapeutic approaches such as the infusion of prostaglandin for ductal patency, the careful maintenance of balance between systemic and pulmonary circulations or operative treatment. In newborns with critical congenital lesions and in patients in the postoperative period management of acute heart failure becomes important. Chronic heart failure as it is understood today is present in patients with cardiomyopathies and in an increasing number of pediatric patients after palliative surgery. In heart failure due to left-to-right shunts a similar activation of compensatory neurohormonal mechanisms as in adults with chronic heart failure was found. In small clinical trials treatment of these activated compensatory mechanisms with angiotensin-converting enzyme inhibitors and β-blockers showed beneficial effects in pediatric patients. However large clinical multicenter trials as performed in the adult population should be conducted.

Key words

Heart failure - pediatrics - congenital heart disease

1 14th Münster Transplantation Meeting “Heart Failure in Pediatric Patients”, Münster, June 16, 2004

References

  • 1 Balaguru D, Artman M, Auslender M. Management of heart failure in children.  Curr Probl Pediatr. 2000;  30 1-35
    PubMedGoogle Scholar
  • 2 Packer M. How should the physician view heart failure? The philosophical and physiological evolution of three conceptual models of the disease.  Am J Cardiol. 1993;  71 3C-11
    PubMedGoogle Scholar
  • 3 Packer M. Pathophysiology of chronic heart failure.  Lancet. 1992;  340 88-92
    CrossrefPubMedGoogle Scholar
  • 4 Werner N, Böhm M. Stand der medikamentösen Therapie bei Herzinsuffizienz - Wo stehen wir?.  Cardio Compact. 2004;  1 22-31
    PubMedGoogle Scholar
  • 5 Little W C, Cheng C-P. Diastolic dysfunction.  Cardiol Rev. 1998;  82 147-153
    PubMedGoogle Scholar
  • 6 O'Laughlin M P, Fisher D J. Mechanisms of congestive heart failure. Garson A, Bricker JT, Mc Namara DG The Science and Practice of Pediatric Cardiology. Baltimore; Williams & Wilkins 1990: 244-249
    Google Scholar
  • 7 Talner N S. Heart failure. Emmanouilides GC, Allen HD, Riemenschneider TA, Gutgsell HP Moss' and Adams Heart Disease in Infants, Children and Adolescents. Baltimore; Williams & Wilkin 1995: 892-916
    Google Scholar
  • 8 Balaguru D, Haddock P S, Pulgisi J L, Bers D M, Coetzee W A, Artman M. Role of sarcoplasmatic reticulum in contraction and relaxation of immature rabbit ventricular myocytes.  J Mol Cell Cardiol. 1997;  29 2747-2757
    CrossrefPubMedGoogle Scholar
  • 9 Kay J D, Colan S D, Graham Jr T P. Congestive heart failure in pediatric patients.  Am Heart J. 2001;  142 923-928
    CrossrefPubMedGoogle Scholar
  • 10 Roos R D, Bollinger R O, Pinsky W W. Grading the severity of congestive heart failure in infants.  Pediatr Cardiol. 1992;  13 72-75
    CrossrefPubMedGoogle Scholar
  • 11 Driscoll D J, Gillette P C, Duff D F. et al . Hemodynamic effects of dobutamine in children.  Am J Cardiol. 1979;  3 581-585
    PubMedGoogle Scholar
  • 12 Ferman Jr W R. Management of congestive heart failure in the neonate.  Perinatology- Neonatology. 1984;  8 16-26
    PubMedGoogle Scholar
  • 13 Baim D S, Mc Dowell A V, Cherniles J. et al . Evaluation of a new bipyridine inotropic agent - milrinone - in patients with severe congestive heart failure.  N Engl J Med. 1983;  309 748-756
    CrossrefPubMedGoogle Scholar
  • 14 Subhedar N V, Shaw N J. Dopamine versus dobutamine for hypotensive preterm infants (Cochrane Review). The Cochrane Library. Chichester, UK; John Wiley & Sons Ltd 2004 Issue 1
    Google Scholar
  • 15 Artman M, Graham Jr T P. Guidelines for vasodilator therapy of congestive heart failure in infants and children.  Am Heart J. 1987;  113 994-1005
    CrossrefPubMedGoogle Scholar
  • 16 Salvador D RK, Rey N R, Ramos G C, Punzalan F ER. Continuous infusion versus bolus injection of loop diuretics in congestive heart failure (Cochrane Review). The Cochrane Library. Chichester, UK; John Wiley & Sons Ltd 2004 Issue 1
    Google Scholar
  • 17 Flaris R, Flather M, Purcell H, Henein M, Poole-Wilson P, Coats A. Current evidence supporting the role of diuretics in heart failure: a meta analysis of randomised controlled trials.  Int J Cardiol. 2002;  82 149-158
    CrossrefPubMedGoogle Scholar
  • 18 Channer K S, McLean K A, Lawson-Matthew P. et al . Combination diuretic treatment in severe heart failure: a randomised controlled trial.  Br Heart J. 1994;  71 146-150
    PubMedGoogle Scholar
  • 19 Pitt B, Zanad F, Remme W J. et al . The effects of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study (RALES) investigators.  N Engl J Med. 1999;  341 709-717
    Google Scholar
  • 20 The SOLVD Investigators . Effects of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure.  N Engl J Med. 1991;  325 293-302
    CrossrefPubMedGoogle Scholar
  • 21 The SOLVD Investigators . Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fraction.  N Engl J Med. 1992;  327 685-691
    Google Scholar
  • 22 Pfeffer M A, Braunwald E, Moye L A. et al . Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE investigators.  N Engl J Med. 1992;  327 669-677
    PubMedGoogle Scholar
  • 23 Kober L, Torp-Pedersen C, Carlsen J E. et al . A clinical trial of angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) study group.  N Engl J Med. 1995;  333 1670-1676
    CrossrefPubMedGoogle Scholar
  • 24 Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure.  JAMA. 1995;  273 1450-1456
    CrossrefPubMedGoogle Scholar
  • 25 Buchhorn R, Ross R D, Bartmus D, Wessel A, Hulpke-Wette M, Bursch J. Activity of the renin-angiotensin-aldosterone and sympathetic nervous system and their relation to hemodynamics and clinical abnormalities in infants with left-to-right shunts.  Int J Cardiol. 2001;  78 225-230
    CrossrefPubMedGoogle Scholar
  • 26 Sluysmans T, Styns-Cailteux A, Tremouroux-Wattiez M. et al . Intravenous enalapril and oral enalapril in congestive heart failure secondary to ventricular septal defect in infancy.  Am J Cardiol. 1992;  70 959-962
    CrossrefPubMedGoogle Scholar
  • 27 Buchhorn R, Ross R D, Hulpke-Wette M, Bartmus D, Wessel A, Schulz R, Bursch J. Effectiveness of low dose captopril versus propanolol therapy in infants with severe congestive heart failure due to left-to-right shunts.  Int J Cardiol. 2000;  76 227-233
    CrossrefPubMedGoogle Scholar
  • 28 Lewis A B, Chabot M. The effect of treatment with angiotensin-converting enzyme inhibitors on survival of pediatric patients with dilated cardiomyopathy.  Pediatr Cardiol. 1993;  14 9-12
    PubMedGoogle Scholar
  • 29 Kouatil A A, Garcia J A, Zellers T M. et al . Enalapril does not enhance exercise capacity in patients after Fontan procedure.  Circulation. 1997;  96 1507-1512
    PubMedGoogle Scholar
  • 30 Heragu N, Mahony L. Is captopril useful in decreasing pleural drainage in children after modified Fontan procedure?.  Am J Cardiol. 1999;  84 1109-1112
    CrossrefPubMedGoogle Scholar
  • 31 Thompson L D, Mc Ethinney D B, Culberston C B. Perioperative administration of angiotensin converting enzyme inhibitors decrease the severity and duration of pleural effusions following bidirectional cavopulmonary anastomosis.  Cardiol Young. 2001;  11 195-200
    PubMedGoogle Scholar
  • 32 Heidenreich P A, Lee T T, Massie B M. Effect of beta-blockade on mortality in patients with heart failure: a meta-analysis of randomized clinical trials.  J Am College Cardiol. 1997;  30 27-34
    PubMedGoogle Scholar
  • 33 The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial.  Lancet. 1999;  353 9-13
    CrossrefPubMedGoogle Scholar
  • 34 Buchhorn R, Hulpke-Wette M, Hilgers R, Bartmus D, Wessel A, Bursch J. Propanolol treatment of congestive heart failure in infants with congenital heart disease: The CHF-PRO-INFANT Trial. Congestive heart failure in infants treated with propanolol.  Int J Cardiol. 2001;  79 167-173
    CrossrefPubMedGoogle Scholar
  • 35 Giardini A, Formigari R, Bronzetti G, Prandstraller D, Donti A, Bonvicini M, Picchio F M. Modulation of neurohormonal activity after treatment of children in heart failure with carvedilol.  Cardiol Young. 2003;  13 333-336
    PubMedGoogle Scholar
  • 36 Buchhorn R, Bartmus D, Siekmeyer W, Hulpke-Wette M, Schulz R, Bursch J. Beta-blocker therapy of severe congestive heart failure in infants with left to right shunts.  Am J Cardiol. 1998;  81 1366-1368
    CrossrefPubMedGoogle Scholar
  • 37 Shaddy R E, Curtin E L, Sower B, Tani L Y, Burr J, La Salle B, Boucek M M, Mahony L, Hsu D T, Pahl E, Burch G H, Schlencker-Herceg R. The pediatric randomized carvedilol trial in children with heart failure: rationale and design.  Am Heart J. 2002;  144 383-389
    CrossrefPubMedGoogle Scholar
  • 38 Poole-Wilson P A, Swedberg K, Cleland J G. et al . Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial.  Lancet. 2003;  362 7-13
    CrossrefPubMedGoogle Scholar
  • 39 Digitalis Investigation Group . The effects of digoxin on mortality and morbidity in patients with heart failure.  N Engl J Med. 1997;  336 525-533
    CrossrefPubMedGoogle Scholar
  • 40 Rathore S S, Wang Y, Krumholz H M. Sex-based differences in the effect of digoxin for the treatment of heart failure.  N Engl J Med. 2002;  347 1403-1411
    CrossrefPubMedGoogle Scholar
  • 41 Rathore S S, Curtis J P, Wang Y, Bristow M R, Krumholz H M. Association of serum digoxin concentration and outcome in patients with heart failure.  JAMA. 2003;  289 871-878
    CrossrefPubMedGoogle Scholar
  • 42 Schwarz S M, Gewitz M H, See C C, Berezin S, Glassman M S, Medow C M, Fish B C, Newman L J. Enteral nutrition in infants with congenital heart disease and growth failure.  Pediatrics. 1990;  86 368-373
    PubMedGoogle Scholar

1 14th Münster Transplantation Meeting “Heart Failure in Pediatric Patients”, Münster, June 16, 2004

Martin Hoch
Prof. Dr. med. Heinrich Netz

Abteilung für Kinderkardiologie und Päd. Intensivmedizin, Klinikum Großhadern, Ludwig-Maximilians-Universität

Marchioninistraße 15

81377 München

Germany

Email: martin.hoch@med.uni-muenchen.de