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
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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