Korean Circ J.  2024 Dec;54(12):794-810. 10.4070/kcj.2024.0320.

Management of Pediatric Heart Failure

• Dipchand AI

• KMID: 2563794
• DOI: http://doi.org/10.4070/kcj.2024.0320

Abstract

Heart failure (HF) in children is a complex syndrome with multiple diverse etiologies and both acute and chronic presentations. Chronic presentations can persist throughout childhood and adolescence, and require diligent management with ongoing reassessment to maximize survival and quality of life. Stages of HF are key to recognize as they guide both management and inform prognosis. In more severe cases, children can present with signs of low cardiac output and circulatory collapse with potential to transition either to a chronic HF stage or progress to a need for advanced HF therapies. Morbidity and mortality are high. Managing HF requires a multi-disciplinary approach that can adapt to the needs of the different phases of childhood and adolescence. Treatment can include medications, nutritional support, activity modifications, and potentially surgical intervention, pacemaker, respiratory or mechanical support, or even heart transplantation. Limited evidence exists for almost all medical therapies used in the management of HF in children and approaches are predominantly extrapolated from extensive adult experience. There are multiple maladaptive pathways in the failing heart; medications that modify these maladaptive pathways promote “reverse remodelling” of the myocardium and are key to the management, forming the basis for “guideline directed medical therapy”. The purpose of this review is to summarize the current state of the art management of systolic HF in children.

Keyword

Heart failure; Pediatric; Cardiomyopathy; Guideline directed medical therapy

Figure

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  Figure 1 Approach to the management of the pediatric patient with heart failure with reduced ejection fraction (HFrEF).ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker antagonist; ARNI = angiotension receptor-neprilysin inhibitor; CRT = cardiac resynchronization therapy; ECMO = extracorporeal membrane oxygenation; GDMT = guideline directed medical therapy; HF = heart failure; ICD = implantable cardiac defibrillator; MRA = mineralocorticoid receptor antagonist; LVEF = left ventricular ejection fraction; SGLT2i = sodium-glucose cotransporter-2 inhibitor; TIC = tachycardia-induced cardiomyopathy; VAD = ventricular assist device.

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