Proinflammatory cytokines in heart failure in children in combination with pulmonary hypertension

Introduction: Determination of the pathophysiological role of proinflammatory cytokines – IL-1b, IL-6

and TNF-alpha in CHF in children secondary to congenital systemic-to-pulmonary shunts complicated
with PAH of different degree. Methods: The study – 70 children: 0.5 months – 18 years with CHF
secondary to systemic-pulmonary shunts simple, compound and complex with PAH (anatomical and
pathophysiological classification, modified from Venice 2003 SEC HTPA Guide 2009). Depending on the
degree of PAH, patients were divided into 2: group I – 16 children with CHF and moderate PAH (PSAP 50
– 70% of the systemic) and group II – 54 children with CHF and PAH severe degree (PSAP > 70% of the
systemic). After CF NYHA/Ross, in the group I prevailed children with CF II and III, and in the second – CF
III and IV (p < 0.001). The control group 10 kids basically healthy with innocent heart murmur. The groups
were comparable by age and sex. Proinflammatory cytokines were determined by analysis –
immunoferment screening method. Results: At the patients in group I of the study the serum level of IL-
1b was 3.71 ± 0.37 pg/ml vs 10.49 ± 1.56 in the second group (p < 0.05) and 2.74 ± 0.53 healthy children
(p < 0.05, p < 0.001). The amount of IL-6 was 5.5 ± 0.83 pg/ml in group I versus 8.61 ± 0.83 in group II (p =
0.05) and 1.63 ± 0.62 in healthy (p < 0.001). TNF-alpha level was 3.62 ± 0.37 in group I compared with
6.88 ± 0.9 in group II (p > 0.05) and in healthy controls – 1.82 ± 0.91 pg/ml (p < 0.05, p <
0.001). Conclusions: Proinflammatory cytokines – IL-1b, IL-6 and TNF-alpha are relevant to the
pathophysiology of CHF secondary to congenital shunts associated with PAH, their levels increasing with
the severity of this pathology – FC HYHA/ROSS of CHF and level of PAH.

Heart failure syndrome in children based on the ISHLT guide, 2014

Introduction: Heart failure (HF) syndrome is defined by the heart\’s inability to produce cardiac output
syste-mic or pulmonary for tissue needs or to support it un-der increased filling pressures. The purpose.
Studying Heart Failure Syndrome management in Children Ba-sed on the ISHLT Guide, (publication year
2014).
Methods: The article is based on the ISHLT Guidebook (2014), as well as medical publications from
internatio-nal literature, and online material.
Results: HR causes are divided into cardiac and extra-cardiac. The cardiac causes are structural
abnormalities cardiac overload, left-right shunt, pressure overload, valvular insufficiency, but may also
be „normal“ in the regular heart – primary and secondary cardiomyo-pathy. Typical clinical
manifestations in children may be tachypnea, alimentation problems (reflux, vomiting, loss of appetite),
diaphoresis, and palpitations. The pa-raclinical evaluation includes routine analyzes and NT-proBNP, BNP,
CK, MB fractions, cardiac troponins, C-reactive protein and functional and interventional tests (ECG
standard 12 derivates, thoracic radiography + ICT, Echocardiography, Doppler-EcoCG ). Treat-ment of
acute HF includes diuretics, inotropic therapy, milrinone, dobutamine, epinephrine, digoxin, systemic
vasodilators. Chronic HF therapy includes IECA – cap-topril, enalapril, ramipril, perindopril, angiotensin II
receptor antagonists – losartan, beta – blockers, aldost-erone antagonists.
Conclusions: The key to achieving therapeutic success and implicitly the survival of the pediatric patient
is the appreciation and treatment of the HF cause and gradu-al introduction of drug therapy according to
the seve-rity of clinical and paraclinical data.
https://www.romanianjournalcardiology.ro/arhiva/heart-failure-syndrome-in-children-based-on-the-
ishlt-guide-2014/