Abstract Ref Number = APCP48
Current Management of Heart Failure in children
Mahrus Abdur Rahman
Department of Child Health Medical Faculty Airlangga University
Dr Soetomo Hospital Surabaya Indonesia
Pediatric heart failure (HF) is an etiologically diverse disease manifesting a variety of clinical presentations. HF results when cardiac output is insufficient to meet the metabolic demands of the body. Decreased cardiac output leads to a cascade of compensatory responses that are aimed directly or indirectly at restoring normal perfusion to the body’s organs and tissues. HF in children results from excessive preload, excessive afterload, abnormal rhythm, or decreased contractility, which all can lead to a final common HF pathway. Unmet tissue demands for cardiac output result in activation of the renin-aldosteroneangiotensin system, the sympathetic nervous system, cytokine-induced inflammation, and recently appreciated “signaling” cascades that trigger cachexia.
The child presenting with symptoms and signs of HF requires urgent assessment to establish the diagnosis, rapidly determine their hemodynamic status, and identify any reversible causes of HF. Treatment can vary with age and type of disease. HF treatment consist of farmacological and non pharmacological treatment. A treatable cause, such as a rhythm problem, may require specific medications or procedures. Pharmacological therapy can be used as a temporary solution to allow the hole to get smaller or close on its own, or to give the baby a little time to grow prior to heart surgery. In more complex problems when it is known that surgery will be needed, it is currently the practice in most centers to perform surgery in the first weeks of life. Some congenital heart disease cannot undergo surgery and a heart transplant is the only option.
Treatment can also include devices, such as ventricular assist devices (VADs) or the SynCardia Total Artificial. Pharmacological treatment including therapy with diuretic, inotropic agents: low-dose epinephrine, and dobutamine, phosphodiesterase inhibitor: milrinone,vasodilator: nitropruside and nitroglycerine, ACE inhibitors,angiotensin receptor blocker and β-adrenergic receptor blocker. New drugs for heart failure: dopamine-β-hydroxylase inhibition, apoptosis inhibition, G-protein-coupled receptor modifiers, and gene therapy Non pharmacologic terapy for heart failure including : Cardiac resincronization therapy, Catheter device therapy for heart failure: including percutaneous assist devices and valve replacement, stem cell therapy and pediatric heart transplantation. Surgical strategies for the failing systemic ventricle: Fontan convertion for the failed Fontan, double switch operation for patients with ccTGA, ASO for failed atrial switch operation and late ASO for dextroposed transposition of the great arteries. The application of these surgical strategies in regard to timing, candidacy, and expected outcomes is delinated.
Keywords: current, management, heart failure, children