Marc Anders. Heart failure and ventricular assist device (VAD), Don't Forget the Bubbles, 2013. Available at:
Modified Ross heart failure classification:
|II||Mild tachypneoa or diaphoresis with feeding. Dyspnea on exertion in older children|
|III||Marked tachypnea or diaphoresis with feeding; marked dyspnea on exertion; prolonged feeding time with failure to thrive|
|IV||Tachypnea, retractions, grunting or diaphoresis at rest|
- Congenital, skeletal myopathy with cardiac involvment (e.g. Duchenne, Becker, Barth Syndrome, myotonic dystrophy)
- Metabolic disorders with cardiac involvement (carnitine deficiency, glycogen storage disease, mitochondrial disease)
- Cardiomyopathy (primary, secondary)
- Acquired (rheumatic heart disease, myocarditis, tachyarrythmia, toxic, antineoplastic drugs, nutritional deficiency)
Treatment of the underlying cause and cardiomyopathy.
Mechanical treatment options (ECLS):
Short term support: IABP (diastolic augmentation), Impella axial flow (minimum weight 25 kg), centrifugal pumps (Levitronix), ECMO
Mid-term support /bridge to transplantation/bridge to recovery: Thoratec, Berlin heart
References: European Journal of Pediatrics, 2010, 169, 403 – 410: Kantor et all: Clinical Practice: Heart Failure in Children. Part II. Current maintenance therapy and new therapeutic approaches  Circulation 110:975-981: Stevenson LW: Left ventricular assist device as destination for patients undergoing intravenous inotropic therapy: a subset analysis from REMATCH (Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure).  Ann Thorac Surg 1999; 67: 1415-20. Akomea-Agyin: Intraaortic balloon pumpi in children.  J. Thorac. Cardiovasc. Surg., July 1, 2011; 142(1): 60 – 65. Lamarche et al: Comparative outcomes in cardiogenic shock patients managed with Impella microaxial pump or extracorporeal life support  John et al. J Thorac Cardiovasc Surg.2011; 141: 932-939. Outcomes of a multicenter trial of the Levitronix CentriMag ventricular assist system.  Reinhartz O, Keith FM, El-Banayosy A, et al. Multicenter experience with the thoratec ventricular assist device in children and adolescents. J Heart Lung Transplant 2001; 20: 439-48.  Current Cardiology Reviews, 2010, 6, 46-53. Gazit et al: Mechanical Circulatory Support of the Critically Ill Child Awaiting Heart Transplantation.  J Heart Lung Transplant. 2011 Feb;30(2):115-23: Stevenson et al: Third INTERMACS Annual Report: the evolution of destination therapy in the United States.
 Interact Cardiovasc Thorac Surg. 2012 Sep;15(3):426-31. The profile of the systemic inflammatory response in children undergoing ventricular assist device support.