Treatment of dilated cardiomyopathy in children

Treatment goals for dilated cardiomyopathy in children

Along with innovations in the pathogenesis of dilated cardiomyopathy, the last decade has been marked by the emergence of new views on its therapy, but to date, the treatment of dilated cardiomyopathy in children remains mainly symptomatic. Therapy is based on the correction and prevention of the main clinical manifestations of the disease and its complications: chronic heart failure, cardiac arrhythmias, and thromboembolism.

Non-drug treatment of dilated cardiomyopathy in a child

The most optimal is a flexible regimen with limited physical activity in accordance with the severity of the child's functional impairment. Of great importance is the reduction of preload by limiting the intake of liquid and table salt.

Drug treatment of dilated cardiomyopathy in a child

Taking into account the main pathogenetic mechanisms of heart failure (reduced myocardial contractility and decreased mass of viable cardiomyocytes), the main means of its drug treatment are diuretics and vasodilators from the group of ACE inhibitors (captopril, enalapril).

Cardiotonic drugs (digoxin) are added to treatment in cases of significant myocardial dilation and insufficient effectiveness of diuretics and ACE inhibitors in patients with sinus rhythm.

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

In recent years, long-term use of beta-blockers in these patients has been justified, starting with minimal doses and gradually achieving optimal tolerated doses.

In view of the presumed autoimmune pathogenesis of a significant proportion of cases of dilated cardiomyopathy and its association with viral myocarditis, the question arises about the use of immunosuppressive and immunomodulatory drugs in patients.

According to some authors, profound metabolic changes in the myocardium serve as the basis for the use of drugs in patients with dilated cardiomyopathy 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 for heart failure in children and young adults include the following:

• cardiac resynchronization therapy;
• surgical correction of valve pathology:
• reconstructive surgery on the left ventricle;
• the use of devices that reduce the size and change the shape of the left ventricular cavity;
• mechanical circulatory support devices;
• heart transplant.

Forecast

The prognosis of the disease is very serious, although there are isolated reports of significant improvement in the clinical condition of patients with conventional therapy.

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

According to observations of many authors, the most common causes of death in patients with dilated cardiomyopathy are chronic heart failure, thromboembolism and cardiac arrhythmia.

Despite 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 ]