Buchhorn R and Borst MM
Today, in adult cardiology, the efficacy of beta blockers in patients with congestive heart failure is well established. Beta blockers, as a drug class, provide mortality benefits in comparison with placebo, or standard treatment, in patients with mild to severe heart failure. However, 40 years after Waagstein's first reports in adults and 20 years after our reports in infants with congenital heart defects, beta blockers are still a long way from routine clinical use in pediatric heart failure. Pediatric Cardiology has missed this milestone in heart failure treatment because the necessary clinical studies have not been carried out. However, other pediatricians were more attentive. After using propranolol in infants with a cardiomyopathy due to hemangiomatosis, several new specific pediatric indications for propranolol were unveiled and all appear to be related to its vascular effects: Hemangioma - Lymphatic Anomalies - Retinopathy of Prematurity - Refeeding Edema. Perhaps these new investigations will convince pediatric cardiologists to reevaluate propranolol treatment, especially in infants with univentricular hearts in an effort to improve their very high mortality rate. Furthermore, there have been important findings suggesting that oral propranolol induces a significant decrease in endothelial nitric oxide synthase activity and vascular endothelial growth factor levels in children, both of which are important factors in the development of pulmonary vascular disease. Moreover, based upon our long-time data, we developed our “autonomic imprinting” model, that may explain how early life stress due to infant heart failure may impair growth and cognition, and increase cardiovascular risk in later life.
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