Heart failure in children part I: History, etiology, and pathophysiology

Since the earliest characterization of the signs and symptoms of venous congestion in a child with a ventricular septal defect, it has been recognized that the causes of heart failure in children are multifactorial and not limited to the presence of left ventricular dysfunction. Heart failure in children results from etiologies as diverse as volume overload, pressure overload, cyanosis, primary myocardial disease of either or both ventricles, metabolic abnormalities, and genetic mutations. Mechanistic insights into the pathophysiology of heart failure in children, coupled with a molecular understanding of cardiac development, have the potential to identify new therapeutic targets for the treatment of all patients with heart failure. The absence of accurate disease-specific incidence and outcome data are an impediment to research on pediatric heart failure. The European experience illustrates the potential contributions of systematic national databases for pediatric care in general and pediatric heart disease in particular.