Pediatrics

Dietmar Schranz, MD was a Resident and Fellow in Pediatrics, Neonatology, Pediatric Intensive Care & Cardiology with follow-up position as Assistant Professor (PhD) in Pediatric Cardiology and Intensive Care at the Gutenberg University Clinic Mainz, Germany. During 1996-2017 he was a University Professor (C4), Justus-Liebig University Giessen, Germany, Chair of the Department of Pediatric Cardiology, Pediatric Heart Center, JLU-Giessen (Germany). Since 2017 he is a Consultant in University Clinic Frankfurt & Wuxi, China. He has publications of more than 200 peer-reviewed papers in reputed journals and more than 100 invited talks world-wide. He has membership in multiple German & European societies and he is a Reviewer of Lancet, Circulation and many other high-ranked Journals.

 

Heart failure (HF) in children is a serious public health concern. HF has numerous etiologies, but unspecific symptoms. There is interplay among neurohumoral, and molecular abnormalities. Major advances in chronic heart failure (cHF) therapy have been achieved in adult patients, while research regarding the mechanisms and therapy of chronic heart failure in children has lagged behind. However in any case, the current chronic therapy of systolic HF focused on loop-diuretics, fluid restriction and digoxin as well as the definition of end-stage HF is inacceptable; not at least in context of the potentials of regeneration reciprocal to the patient’s age. Therefore, therapy has to extend to selective ß1-blocker, tissue ACE-I and mineralocorticoid blockers, and loop-diuretics avoided as ever possible. The efficacy of endogenous neurohumoral inhibition can easily monitored, even by parents only looking at surrogate parameters as heart and breath rate as well as systolic and diastolic blood pressure. Echocardiographic control of cardiac function has to include synchrony and parameters of ventriculo-ventricular interaction (VVI). Optimizing the left ventricular preload is advocated as an 

important part of a regenerative strategy. Interventional aspects of such a regenerative favored HF therapy include creation of a restrictive interatrial communication, placing a reversible pulmonary artery banding and stem cells replacement.