Pediatric Heart Center, University of Giessen and Marburg, Feulgenstrasse 12, 35390, Giessen, Germany.
Heart Fail Rev. 2018 Jul;23(4):555-562. doi: 10.1007/s10741-018-9692-1.
While in adults major advances in heart failure therapy in patients with dilated cardiomyopathy were documented in the last two decades, research on the mechanism and therapies of heart failure in children with left ventricular dilated cardiomyopathy has lagged behind. Despite the lack of sufficient randomized prospective studies, ACE inhibitors are first line and ß-receptor antagonists are second-line strategies in children. Following the adult guidelines, without having data concerning the pediatric population, mineral corticoids are also accepted in the treatment of pediatric heart failure, while diuretics should only be used to achieve a euvolemic status. In cases of complete left bundle bunch block or prolonged QRS duration, cardiac resynchronization is an option. If these instruments are exploited, and the child is still listed for heart transplantation as destination, evolving therapies like pulmonary artery banding in cases of preserved right ventricular function and cardiac cell therapy in cases of localized ventricular dysfunction might represent additional treatment options. This review summarizes the actual guidelines and provides an outlook for evolving therapies.
虽然在过去的二十年中，成人扩张型心肌病心力衰竭的治疗取得了重大进展，但儿童扩张型心肌病心力衰竭的机制和治疗研究却相对滞后。尽管缺乏充分的随机前瞻性研究，但 ACE 抑制剂是一线治疗药物，β受体拮抗剂是二线治疗策略。根据成人指南，尽管没有儿科人群的数据，但在治疗儿科心力衰竭时也接受盐皮质激素，而利尿剂仅应用于达到正常血容量状态。对于完全性左束支传导阻滞或 QRS 持续时间延长的患者，心脏再同步是一种选择。如果这些方法得到应用，并且该儿童仍被列为心脏移植的对象，那么在保留右心室功能的情况下进行肺动脉环缩术和在局部心室功能障碍的情况下进行心脏细胞治疗等新兴疗法可能代表着额外的治疗选择。本文综述了现有的指南，并展望了新兴的治疗方法。
