Recovery of heart function in children with acute severe heart failure.
BACKGROUND
The prognosis of acute heart failure is such that many children are considered for transplantation. Recovery of severe heart failure in a proportion of patients diagnosed with either dilated cardiomyopathy or myocarditis is well recognized, and this complicates the assessment for transplantation. There is little data on the time scale of recovery of heart function in children.


OBJECTIVE
To describe the time course over which echocardiographic improvement of systolic function occurred in a cohort of children who presented in acute heart failure, without structural or metabolic abnormality.


METHODS
Children with a first presentation of acute severe heart failure between 1990 and 2005. Time from presentation to the echocardiogram before left ventricular fractional shortening (FS) improved to 20% and 30% (complete recovery) was recorded.


RESULTS
Twenty-seven children (11 male) were identified, and all had an initial FS <15%. Twenty-one patients required intravenous inotropes and three patients required extracorporeal membrane oxygenation. Seven patients had been on the active transplant list for a mean duration of 155 days. Four patients had probable viral myocarditis. Mean age at presentation was 15.7 (range, 0.1-72) months. Mean time to an FS of 20% was 3.6 (0.2-18) months and to 30% was 8.9 (0.7-24) months. Complete recovery occurred within 6, 9, 12, 18, and 24 months of presentation in 44%, 55%, 66%, and 96%, respectively. There was no correlation between age of presentation and length of time to recovery.


CONCLUSIONS
Complete recovery of left ventricular systolic function is often delayed to more than 1 year from presentation. This may have major implications for timing of transplantation in an era where prolonged mechanical cardiac support is feasible even in infants.
O'Sullivan
John J
JJ
Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom. j.j.osullivan@ncl.ac.uk
Roche
Susan L
SL
Crossland
David S
DS
Chaudhari
Milind P
MP
Kirk
Richard C
RC
Asif
Hasan
H
D000208:Acute Disease; D002216:Captopril / Q000627:therapeutic use; D002227:Carbazoles / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D000077261:Carvedilol; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004077:Digoxin / Q000627:therapeutic use; D004656:Enalapril / Q000627:therapeutic use; D017335:Enoximone / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology*; D006334:Heart Function Tests; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011412:Propanolamines / Q000627:therapeutic use; D016896:Treatment Outcome
D002227:Carbazoles; D002316:Cardiotonic Agents; D011412:Propanolamines; D000077261:Carvedilol; D004656:Enalapril; D004077:Digoxin; D002216:Captopril; D017335:Enoximone