Acute Heart Failure in Childhood: Pathophysiology and Treatment

  • D. J. Bohn
  • S. R. Keeley
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 6)


The underlying mechanisms and pathophysiology of acute heart failure in the pediatric age group differ significantly in many respects from that seen in adult patients. Therefore it is important that the differences in structure and function of the myocardium in the newborn, the transition to a more adult pattern in the older child and the different causes of acute heart failure in children compared to adults, be taken into account in considering therapy.


Cardiac Output Pulmonary Hypertension Right Ventricular Mean Arterial Pressure Pulmonary Vascular Resistance 
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  1. 1.
    Zak R, Kizo A, Bugaisky L (1979) Cardiac hypertrophy: Its characteristics as a growth process. Am J Cardiol 44: 941–946PubMedCrossRefGoogle Scholar
  2. 2.
    Legato MJ (1979) Cellular mechanisms of normal growth in the mammalian heart I. Qualitative and quantitative features of ventricular architecture in the dog from birth to five months of age. Circ Res 44: 250–262PubMedGoogle Scholar
  3. 3.
    Legato MJ (1979) Cellular mechanisms of normal growth in the mammalian heart II. A quantitative and qualitative comparison between the right and left ventricular myocytes in the dog from birth to five months of age. Circ Res 44: 263–279PubMedGoogle Scholar
  4. 4.
    Epstein MC, Goldberg SJ, Allen HD, et al (1975) Great vessel, cardiac chamber and wall growth patterns in normal children. Circulation 51: 1124–1129PubMedGoogle Scholar
  5. 5.
    Oberhansli I, Brandon G, Lacourt G, et al (1980) Growth patterns of cardiac structures and changes in systolic time intervals in the newborn and infant. Acta Paediatr Scand 69: 239–247PubMedCrossRefGoogle Scholar
  6. 6.
    Friedman WF (1972) The intrinsic physiologic properties of the developing heart. Prog Cardiovasc Dis 15: 87–111PubMedCrossRefGoogle Scholar
  7. 7.
    Friedman WF (1973) The intrinsic physiologic properties of the developing heart. In: Friedman WF, Lesch M, Sonnenblick EH (eds) Neonatal Heart Disease. Grune & StrattonGoogle Scholar
  8. 8.
    Berman W, Christensen D (1983) Effects of acute preload and afterload stress on myocardial function in newborn and adult sheep. Biol Neonate 43: 61–66PubMedCrossRefGoogle Scholar
  9. 9.
    Berman W, Musselman J (1979) Myocardial performance in newborn lambs. Am J Physiol 237: H66 - H70PubMedGoogle Scholar
  10. 10.
    Klopfenstein HS, Rudolph AM (1978) Post natal changes in the circulation and responses to volume loading in the sheep. Circ Res 42: 839–845PubMedGoogle Scholar
  11. 11.
    Romero TE, Friedman WF (1979) Limited left ventricular response to volume overload in the neonatal period: A comparative study with the adult animal. Paediatr Res 13: 910–915CrossRefGoogle Scholar
  12. 12.
    Reimschneider TA, Allen HD, Mason DT, et al (1986) Maturational changes in myocardial pump performance in newborn lambs. Am Heart J 111: 731–736CrossRefGoogle Scholar
  13. 13.
    Recavarren S, Arias-Stella J (1964) Growth and development of the ventricular myocardium from birth to adult life. Br Heart J 26: 187–192PubMedCrossRefGoogle Scholar
  14. 14.
    Baylen BG, Ogata H, Ikegami M, et al (1986) Left ventricular performance and contractility before and after volume infusions: a comparative study of pre-term and full-term newborn lambs. Circulation 73: 1042–1049PubMedCrossRefGoogle Scholar
  15. 15.
    Teitel DF, Sidi D, Chin T, et al (1985) Developmental changes in myocardial contractile reserve in the lamb. Paediatr Res 19: 948–955CrossRefGoogle Scholar
  16. 16.
    Driscoll DJ, Gillette PC, Ezrailson EG, Schwartz A (1978) Inotropic response of the neonatal canine myocardium to dopamine. Paediatr Res 12: 42–45Google Scholar
  17. 17.
    Driscoll DJ, Gillette PC, Lewis RM, et al (1978) Comparative hemodynamic effects of isoproteronol, dopamine and dobutamine in the newborn dog. Paediatr Res 13: 1006–1009Google Scholar
  18. 18.
    Lucking SE, Pollack MM, Fields Al (1986) Shock following generalised hypoxic-ischaemic injury in previousy healthy infants and children. J Paediatr 108: 359–364CrossRefGoogle Scholar
  19. 19.
    English ICW, Frew RM, Pigott JF, et al (1969) Percutaneous catheterisation of the internal jugular vein. Anaesthesia 24: 521–531PubMedCrossRefGoogle Scholar
  20. 20.
    Groff DB, Ahmed N (1974) Subclavian vein catheterisation in the infant. J Paediatr Surg 9: 171–174CrossRefGoogle Scholar
  21. 21.
    Pollack MM, Reed TP, Holbrook PR, Fields AI (1980) Bedside pulmonary artery catheterisation in paediatrics. J Paediatr 96: 274–276CrossRefGoogle Scholar
  22. 22.
    Fanconi S, Doherty P, Edmonds JF, Barker GA, Bohn D (1985) Pulse oximetry in paediatric intensive care: comparison with measured saturations and transcutaneous oxygen tension. J Paediatr 107: 362–366CrossRefGoogle Scholar
  23. 23.
    Drummond WH (1980) Cardiopulmonary dopamine response in chronically catheterized neonatal lambs. Circulation (Suppl III ) 62: 25Google Scholar
  24. 24.
    Seri I, Tulassy T, Kiszel J, Machay T, Csomor S (1984) Cardiovascular response to dopamine in hypotensive preterm neonates with severe hyaline membrane disease. Eur J Paediatr 142: 3–9CrossRefGoogle Scholar
  25. 25.
    DiSessa TG, Leitner M, Ching C, et al (1981) The cardiovascular effects of dopamine in severely asphyxiated neonates. J Paediatr 99: 772–776CrossRefGoogle Scholar
  26. 26.
    Padbury JF, Agata Y, Baylen BG, et al (1986) Dopamine pharmacokinetics in critically ill newborn infants. J Paediatr 110: 293–298CrossRefGoogle Scholar
  27. 27.
    Walther FJ, Siassi B, Ramadan NA, Wu PY-K (1985) Cardiac output in newborn infants with transient myocardial dysfunction. J Paediatr 107: 781–785CrossRefGoogle Scholar
  28. 28.
    Williams DB, Kiernan PD, Schaff HV, Marsh HM, Danielson GK (1982) The hemodynamic response to dopamine and nitroprusside following right atrium-pulmonary artery bypass ( Fontan procedure ). Ann Thorac Surg 34: 51–57PubMedCrossRefGoogle Scholar
  29. 29.
    Stephenson LW, Edmunds LH Jr, Raphaely R, Morrison DF, Hoffman WS, Rubis LJ (1979) Effects of nitroprusside and dopamine on pulmonary arterial vasculature in children after cardiac surgery. Circulation 60: 104–110PubMedGoogle Scholar
  30. 30.
    Lang P, Williams RG, Norwood WI, Castaneda AR (1980) The hemodynamic effects of dopamine in infants after corrective cardiac surgery. J Paediatr 96: 630–634CrossRefGoogle Scholar
  31. 31.
    Driscoll DJ, Gillette PC, Duff DF, McNamara DG (1979) The hemodynamic effect of dopamine in children. J Thorac Cardiovasc Surg 78: 765–768PubMedGoogle Scholar
  32. 32.
    Driscoll DJ, Gillette PC, Duff DF, et al (1979) Hemodynamic effects of dobutamine in children. Am J Cardiol 43: 581–585PubMedCrossRefGoogle Scholar
  33. 33.
    Bohn DJ, Poirier CS, Edmonds JF, Barker GA (1980) Hemodynamic effects of dobutamine after cardiopulmonary bypass in children. Crit Care Med 8: 367–371PubMedCrossRefGoogle Scholar
  34. 34.
    Schranz D, Stopfkuchen H, Jungst BK, Clemens R, Emmrich P (1982) Hemodynamic effects of dobutamine in children with cardiovascular failure. Eur J Paediatr 139: 4–7CrossRefGoogle Scholar
  35. 35.
    Perkin RM, Levin DL, Webb R, Aquino A, Reedy J (1982) Dobutamine: A hemodynamic evaluation in children with shock. J Pediatr 100: 977–983PubMedCrossRefGoogle Scholar
  36. 36.
    Berner M, Rouge JC, Friedli B (1983) The hemodynamic effect of phentolamine and dobutamine after open heart operations in children: influence of the underlying defect. Ann Thorac Surg 35: 643–650PubMedCrossRefGoogle Scholar
  37. 37.
    Fiser DH, Fewell JE, Hill DE, Brown AL (1988) Cardiovascular and renal effects of dopamine and dobutamine in healthy conscious piglets. Crit Care Med 16: 340–345PubMedCrossRefGoogle Scholar
  38. 38.
    Rudolph AM, Mesel E, Levy JM (1963) Epinephrine in the treatment of cardiac failure due to shunts. Circulation 28: 3–13PubMedGoogle Scholar
  39. 39.
    Benson LN, Bohn D, Edmonds JF, et al (1979) Nitroglycerine treatment in children with low cardiac index after heart surgery. Cardiovasc Med 4: 207–215Google Scholar
  40. 40.
    Ilbawi MN, Indriss FS, DeLeon S, Berry TE, Duffy CE, Paul MH (1985) Hemodynamic effects of intravenous nitroglycerine in pediatric patients after heart surgery. Circulation (Suppl II ) 72: 101–107Google Scholar
  41. 41.
    Rudinsky BF, Koniar KJ, Strates E, et al (1987) Neither nitroglycerine nor nitroprusside selectively decreases sepsis induced pulmonary hypertension in piglets. Crit Care Med 15: 1127–1130PubMedCrossRefGoogle Scholar
  42. 42.
    Butt W, Bohn DJ, Whyte H (1986) Clinical experience with systemic vasodilator therapy in the newborn infant. Austr Paediatr J 22: 117–120Google Scholar
  43. 43.
    Appelbaum A, Blackston EH, Kouchoukos NT, Kirklin JW (1977) Afterload reduction and cardiac output in infants early after intracardiac surgery. Am J Cardiol 39: 445–451PubMedCrossRefGoogle Scholar
  44. 44.
    Benzing G III, Helmsworth JA, Schreiber JT, Loggie J, Kaplan S (1976) Nitroprusside after open heart surgery. Circulation 54: 467–471PubMedGoogle Scholar
  45. 45.
    Beekman RH, Rocchini AP, Macdonald D II, Crowley DC, Rosenthal A (1984) Vasodilator therapy in children: Acute and chronic effects in children with left ventricular dysfunction or mitral regurgitation. Paediatrics 73: 43–51Google Scholar
  46. 46.
    Neal W, Pierpont M (1981) Effect of amrinone on cardiac function in children with severe congestive heart failure. (abstract) Paediatr Res 15 (4.2): 469CrossRefGoogle Scholar
  47. 47.
    Binah O, Rosen MR (1983) Developmental changes in the cardiac effects of amrinone in the dog. Circ Res 52: 747–752PubMedGoogle Scholar
  48. 48.
    Ross-Ascuitto N, Ascuitto R, Clen V, et al (1987) Negative inotrope effects of amrinone in the neonatal piglet heart. Circ Res 61: 847–852PubMedGoogle Scholar
  49. 49.
    Wheller J, George BL, Mulder DG, Jarmakani JM (1979) Diagnosis and management of postoperative pulmonary hypertensive crisis. Circulation 60: 1640–1644PubMedGoogle Scholar
  50. 50.
    Jones ODH, Shore DF, Rigby ML, et al (1981) The use of tolazoline hydrochloride as a pulmonary vasodilator in potentially fatal episodes of pulmonary vasoconstriction after cardiac surgery in children. Circulation 64 (Suppl II): 134–139Google Scholar
  51. 51.
    Drummond WH, Gregory GA, Hejmann MA (1987) The independent effects of hyperventilation, tolazoline and dopamine on infants with persistent pulmonary hypertension. J Paediatr 98: 603–611CrossRefGoogle Scholar
  52. 52.
    Salmenpera M, Heinonen J (1986) Pulmonary vascular responses to moderate changes in PaCO2 after cardiopulmonary bypass. Anesthesiology 64: 311–315PubMedCrossRefGoogle Scholar
  53. 53.
    Jenkins J, Lynn A, Edmonds J, Barker GA (1985) Effects of mechanical ventilation on cardiopulmonary function in children after open-heart surgery. Crit Care Med 13: 77–80PubMedCrossRefGoogle Scholar
  54. 54.
    Burrows FA, Klinck JR, Rabinovitch M, Bohn DJ (1986) Pulmonary hypertension in children: perioperative management. Can Anaesth Soc J 33: 606–628PubMedCrossRefGoogle Scholar
  55. 55.
    Holloway EL, Polumbo RA, Harrison DC (1975) Acute circulatory effects of dopamine in patients with pulmonary hypertension. Br Heart J 37: 482–485PubMedCrossRefGoogle Scholar
  56. 56.
    Peckham GJ, Fox WW (1978) Physiologic factors affecting pulmonary artery pressure in infants with persistent pulmonary hypertension. J Paediatr 93: 1005–1010CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • D. J. Bohn
  • S. R. Keeley

There are no affiliations available

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