Medical therapy in dilated cardiomyopathy and pulmonary arterial banding in children

Recla, Sabine; Steinbrenner, B.; Schranz, Dietmar

doi:10.1016/j.healun.2013.07.005

Cited by 10 publications

(9 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…During catecholamine infusion therapy, strategies designed to protect the myocardium should be considered, for example: a combination of epinephrine or norepinephrine infusion with ß1-receptor blockers. In decompensated systolic heart failure, which often occurs in infants and children with dilated cardiomyopathy, short-term epinephrine infusion combined with intravenous or oral ß1-receptor blocking agents (metoprolol, bisoprolol) is not a contradiction, but an actually used and recommended strategy [ 43 ]. In addition, it has to emphasize that the right and left heart does not act in isolation; cardiac re-synchronization [ 35 ] as well as strategies to improve the ventricular-ventricular interaction (VVI) is desirable in order to allow endogenous cardiac repair, in particular in younger patients [ 53 , 61 ].…”

Section: Considerationsmentioning

confidence: 99%

“…Taking into account-specific exclusion criteria, at our institution, the chronic, age-independent heart failure therapy consists of specific long-acting ß1-adrenoreceptor blocker (bisoprolol), long-acting tissue angiotensin-converting enzyme inhibitor (lisinopril), and mineralocorticoid-receptor blocker (spironolactone) and applying a goal-oriented drug dosage [ 43 ]. Digoxin is the fourth-line HF drug with a target of a plasma level of 0.5–0.9 ng/ml.…”

Section: Recommendations To Improve Chronic Hf Treatment In Infants Amentioning

confidence: 99%

“…Considering the (patho-)physiology of the ß-adrenergic receptors (ß-AR) in pediatric DCM, highly selective ß1-AR blockers are recommended in children to treat chronic HF caused by LV-DCM [ 34 , 43 , 50 ]. It is generally accepted that chronic stimulation of the cardiac β1-adrenergic system is toxic to the heart and contributes to the pathogenesis of congestive heart failure [ 11 ].…”

Section: Recommendations To Improve Chronic Hf Treatment In Infants Amentioning

confidence: 99%

See 2 more Smart Citations

“Nihilism” of chronic heart failure therapy in children and why effective therapy is withheld

Schranz

Voelkel

2016

Eur J Pediatr

Self Cite

View full text Add to dashboard Cite

Major advances in chronic heart failure (cHF) therapy have been achieved and documented in adult patients, while research regarding the mechanisms and therapy of cHF in children has lagged behind. Based on receptor physiological studies and pharmacological knowledge, treatment with specific ß1-adrenergic receptor blocker (ARB), tissue angiotensin-converting enzyme inhibitor (ACE-I), and mineralocorticoid antagonists have to be recommended in children despite lack of sufficient data derived from prospective randomized studies. At our institution, bisoprolol, lisinopril, and spironolactone have been firmly established to treat systolic cHF, hypoplastic left heart syndrome (HLHS) following hybrid approach and congenital left-right shunt diseases, latest in patients where surgery has to be delayed. Chronic therapy with long-acting diuretics and fluid restriction are not advocated because short-term effects are achieved at the expense of further neuro-humoral stimulation. It remains unclear why diuretics are recommended although evidence-based studies, documenting long-term benefit, are missing. However, that is true for all currently used drugs for pediatric cHF.Conclusion: This review focuses on the prevailing “nihilism” of cHF therapy in children with the goal to encourage physicians to treat pediatric cHF with a rationally designed therapy, which combines available agents that have been shown to improve survival in adult patients with cHF. Because of the lack of clinical trials, which generate the needed evidence, surrogate variables like heart and respiratory rate, weight gain, image-derived data, and biomarkers should be monitored and used instead. The recommended pharmacological therapy for systolic heart failure is also provided as the basis for utilizing reversible pulmonary arterial banding (PAB) as a novel strategy in young children with dilative cardiomyopathy (DCM) with preserved right ventricular function. What is Known: • Heart failure (HF) in children is a serious public health concern. • HF has numerous etiologies, but unspecific symptoms. • HF interplays among neuro-humoral, and molecular abnormalities. • Pediatric cHF-therapy is currently based on loop-diuretics, fluid restriction and digoxin. What is New: • Cardiac function analysis has to include cardiac synchrony and VVI. • Considering enormous potential of cardiac regeneration, therapy has to extend with selective ß1-ARB, tissue ACE-I and mineralocorticoid blockers, loop-diuretics avoided as ever possible. • Inhibition of the endogenous neuro-humoral stimulation is monitored by surrogate parameters as heart and breath rate and systolic and diastolic blood pressure. • Advocated HF therapy serves for regenerative strategies as reversible Pulmonary Artery Banding in DCM. Electronic supplementary materialThe online version of this article (doi:10.1007/s00431-016-2700-3) contains supplementary material, which is available to authorized users.

show abstract

Section: Considerationsmentioning

confidence: 99%

Section: Recommendations To Improve Chronic Hf Treatment In Infants Amentioning

confidence: 99%

Section: Recommendations To Improve Chronic Hf Treatment In Infants Amentioning

confidence: 99%

See 1 more Smart Citation

“Nihilism” of chronic heart failure therapy in children and why effective therapy is withheld

Schranz

Voelkel

2016

Eur J Pediatr

Self Cite

View full text Add to dashboard Cite

show abstract

“…The loop diuretic furosemide can be also added to the treatment, if the patient suffers from pulmonary edema. [6] In our case, we followed the same strategy for PAB procedure. Captopril as an ACEI and digoxin for tachycardia were used after PAB.…”

Section: Discussionmentioning

confidence: 99%

Can heart transplantation be postponed or avoided by pulmonary artery banding in an infant with dilated cardiomyopathy? First experience from Turkey

Ayyıldız¹

2016

Turk Gogus Kalp Dama

View full text Add to dashboard Cite

Bu yazıda etyolojisi bilinmeyen dilate kardiyomiyopatili altı aylık bir süt çocuğu sunuldu. Medikal tedaviye rağmen kalp yetersizliği gerilemeyen olguda kalp nakli endikasyonu vardı. Pulmoner arter bantı, kompleks şantlı olgularda veya sistemik dolaşımda morfolojik sağ ventrikülü olan ve doğuştan düzeltilmiş büyük arterlerin transpozisyonu gibi anatomik biventrikül tamirine uygun olan adaylarda, pulmoner arterdeki kan akımını kısıtlamak için kullanılan eski bir cerrahi tekniktir. Türkiye'de ve dünyada donör sayısındaki azlık ile birlikte çok uzun bekleme süresi nedeniyle, olgumuza pulmoner arter bantı uygulandı. Kalp yetmezliği semptomları büyük ölçüde geriledi ve hasta klinik semptomlarda iyileşme ile kısa bir sürede taburcu edildi. Altı ayda bir yapılan poliklinik takiplerinde sonuçlar normaldi. Anah tar söz cük ler: Dilate kardiyomiyopati; yenidoğan; pulmoner arter bandı.

show abstract

“…Our medical strategy for the long-term treatment of patients with dilated cardiomyopathy was summarised recently. 11 The cornerstone for long-term treatment of chronic heart failure consists of a triple drug regime as follows: the angiotensin-converting enzyme inhibitor lisinopril, the β1-selective blocker bisoprolol, and the aldosterone receptor antagonist spironolactone. By reducing and avoiding chronic diuretic treatment, the goal was to achieve effective dosages of lisinopril and bisoprolol, both given once per day in a final dosage of 0.1-0.2 mg/kg.…”

Section: Patientsmentioning

confidence: 99%

Upgraded heart failure therapy leads to an improved outcome of dilated cardiomyopathy in infants and toddlers

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

Medical therapy in dilated cardiomyopathy and pulmonary arterial banding in children

Cited by 10 publications

References 6 publications

“Nihilism” of chronic heart failure therapy in children and why effective therapy is withheld

“Nihilism” of chronic heart failure therapy in children and why effective therapy is withheld

Can heart transplantation be postponed or avoided by pulmonary artery banding in an infant with dilated cardiomyopathy? First experience from Turkey

Upgraded heart failure therapy leads to an improved outcome of dilated cardiomyopathy in infants and toddlers

Contact Info

Product

Resources

About