Treatment of dilated cardiomyopathy in children

The goals of treatment of dilated cardiomyopathy in children

Along with innovations in the pathogenesis of dilated cardiomyopathy, the last decade has been marked by the appearance of new views on her therapy, but till now the treatment of dilated cardiomyopathy in children remains mostly symptomatic. Therapy is based on the correction and prevention of the main clinical manifestations of the disease and its complications: chronic heart failure, heart rhythm disorders and thromboembolism.

Non-pharmacological treatment of dilated cardiomyopathy in a child

The most optimal is the flexible regime with the restriction of physical activity, respectively, the severity of violations of the functional state of the child. Of great importance is the reduction in preload due to the restriction of fluid intake and table salt.

Medicamental treatment of dilated cardiomyopathy in a child

Taking into account the main pathogenetic mechanisms of heart failure (reduction of contractility of the myocardium and reduction of the weight of viable cardiomyocytes), diuretics and vasodilators from the group of ACE inhibitors (captopril, enalapril) serve as the main agents of its medicamentous treatment.

Cardiotonic drugs (digoxin) are added to treatment with significant myocardial dilatation and inadequate efficacy of diuretics and ACE inhibitors in patients with sinus rhythm.

Antiarrhythmic therapy is used according to the indications, taking into account the fact that these drugs (except for amiodarone) give a negative inotropic effect.

In recent years, the long-term use of beta-adrenoblockers in these patients has been justified, starting with minimal doses with the gradual achievement of optimal tolerated doses.

In view of the alleged autoimmune pathogenesis of a significant part of the cases of dilated cardiomyopathy and its association with viral myocarditis, the question arises of the use of immunosuppressive and immunomodulating drugs in patients.

Deep metabolic changes in the myocardium, according to some authors, serve as the basis for the use in drugs with dilated cardiomyopathy drugs that improve the metabolism of the affected myocardium (neoton, mildronate, carnitine, multivitamins + other drugs, cytoflavin).

Surgical treatment of dilated cardiomyopathy in a child

The main types of non-pharmacological treatment of heart failure in children and young people include the following:

• resynchronizing therapy of cardiac activity;
• surgical correction of valvular pathology:
• reconstructive operations on the left ventricle;
• the use of devices that reduce the size and shape of the cavity of the left ventricle;
• devices of mechanical support of blood circulation;
• heart transplantation.

Forecast

The prognosis of the disease is very serious, although there are some reports of a significant improvement in the clinical state of patients on the background of conventional therapy.

The criteria for the prognosis include the duration of the disease after diagnosis, clinical symptoms and severity of heart failure, the presence of low-voltage type of electrocardiogram. Ventricular arrhythmias of high grades, the degree of reduction of the contractile and pumping functions of the heart. The average life expectancy of patients with dilated cardiomyopathy is 3.5-5 years. The opinions of different authors differ when studying the outcome of dilated cardiomyopathy in children. The highest survival rate was observed in young children.

According to many authors, chronic heart failure, thromboembolism and heart rhythm disturbances are the most frequent causes of death of patients with dilated cardiomyopathy.

Despite the intensive treatment and the search for new drugs for the treatment of dilated cardiomyopathy, the issue of heart transplantation remains relevant. With modern immunosuppressive therapy, the 5-year survival rate of patients with a transplanted heart reaches 70-80%.

[1], [2], [3], [4]