ABSTRACT
Unique aspects of end stage heart failure in children center around the diversity of
underlying disease presenting in infancy and childhood, whether in the form of congenital
cardiac malformation or cardiomyopathy. Device experience in children and young adults
with advanced heart disease is less extensive than in adults, but a considerable knowledge
base is developing nonetheless. Common to all these therapies are concerns about long-
term effects in the growing and developing child, who may experience a many-fold
increase in body size after therapy, and has a life expectancy significantly longer than the
majority of adult patients receiving similar therapies. Challenges arise in attempting to
“retrofit” adult therapies for pediatric patients who display important developmental
differences in size, configuration, and physiologic response of the heart and vasculature.
Etiologies of pediatric heart failure and cardiomyopathy also differ dramatically from
those commonly encountered in adults. Therefore, some aspects of such therapy are
unique to children and to those with congenital heart disease; these features will be the
focus of this section.
