[Cardiac failure in children].

The understanding of cardiac failure pathophysiology in children has advanced greatly in recent years. Whilst cardiac failure secondary to left ventricular dysfunction with viral or metabolic cardiomyopathy is comparable in pathophysiological terms with adults, other aetiological mechanisms are also implicated, linked both to anatomical anomalies in congenital cardiopathy and their surgical repair. The role of the neuroendocrine system with adrenergic activation of the renin-angiotensin system, secretion of natriuretic peptides and the inflammatory system, before and during surgical repair procedures, have been proven both experimentally and clinically. Understanding these pathophysiological mechanisms opens new therapeutic perspectives for improving the management of children with congenital cardiopathy in cardiac failure and reducing postoperative mortality and morbidity.