Abstract

Until the end of the 1990s heart failure due to congenital heart disease was treated as a hemodynamic disorder with very little attention to activation of the endogeneous neurohormonal systems. In recent years the results of clinical studies with infants and children with congenital heart disease have strongly confirmed the neurohormonal theory of the pathogenesis of development of heart failure. According to this theory the main role in development of heart failure symptoms is played mainly by consistent activation of the sympathetic nervous system but not by hemodynamic abnormalities (e.g. low systemic cardiac output, pulmonary overcirculation). The ethiologic treatment of heart failure in congenital heart disease is surgical, however, often heart failure develops in infants in an age, when operative risks are too high. Hence these patients require such medical approach to symptoms which could reduce surgical risks due to young age and low body weight. Considering these circumstances and as well as the benefits of beta-blocker therapy in adult patients with heart failure, beta-blockers were introduced in the pathogenetic treatment of severe heart failure in infants with congenital heart disease. This approach has proved effective and has yielded good results in alleviating heart failure symptoms and in interrupting the process of myocardial remodelling. The present article reviews the general principles of the neurohormonal theory of heart failure and new data from clinical studies of pediatric heart failure, particularly advances in understanding the pathogenetic mechanisms and treatment of this disorder.