Clinical practice: heart failure in children. Part II: current maintenance therapy and new therapeutic approaches.

The current maintenance treatment for children with heart failure remains controversial: To a large extent, it is based on extrapolation of data derived from trials in adult populations. There are only a few randomized trials focused on the treatment of children with cardiac disease, especially in the subgroup with cardiomyopathy and heart failure. The goals of therapy are to maintain circulatory and end-organ function and to allow for recovery and reverse remodeling to occur. When maintenance therapy fails and medical treatment does not result in clinical improvement, the alternative of device therapy must be considered: In that case, the usual aim is to stabilize circulatory status, as a bridge to either recovery or to cardiac transplantation. Recently, carefully selected patients with electromechanical dyssynchrony of ventricular systolic function have demonstrated a benefit from biventricular pacing devices (cardiac resynchronization therapy), with improved functional capacity and quality of life and, in some patients, avoidance of the need for transplantation.