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New-onset heart failure in children in the absence of structural congenital heart disease.

The dramatic advances in the operative and perioperative care of children with major forms of congenital heart disease have resulted in excellent short- and medium-term outcomes for the most severe forms of heart disease, including those with so-called single-ventricle physiology. This represents one of the great advances in pediatrics over the last 3 decades. A corollary of these observations is that some of the worst outcomes for children with heart disease are now observed in those with cardiomyopathy (whether acquired or congenital). This fact has drawn focus on heart muscle disease as an important cause of morbidity and mortality in children.

Article p 79 

Data from the Registry of the International Society for Heart and Lung Transplantation1 emphasize that cardiomyopathies (notably the dilated form) remain the main indication for heart transplantation in childhood. This international report provides very limited information, however, on outcomes before transplantation. The Pediatric Heart Transplant Study, a multi-institutional research consortium from 3 countries, has focused (since 1993) on identifying risk factors for various outcomes from the time of listing for transplantation in children with end-stage heart disease, the majority of whom have cardiomyopathy.2,3 This has provided important information on pretransplantation morbidity and mortality rates in children with advanced heart disease but does not address the epidemiology or outcomes for children at first presentation with heart failure unrelated to structural heart disease.

Recently, 2 groups have provided population-based data on pediatric …