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(Circulation. 1960;21:424.)
© 1960 American Heart Association, Inc.

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SYMPOSIUM ON CONGESTIVE HEART FAILURE

Pediatric Aspects of Congestive Heart Failure

ALEXANDER S. NADAS M.D.¹ ANNA J. HAUCK M.D.¹

¹ From the Department of Pediatrics, Harvard Medical School, and the Sharon Cardio-Vascular Unit of the Children's Medical Center, Boston, Mass.

Congestive failure in infancy and childhood may occur in a number of diseases. Congenital heart disease. however, is probably the most common cause of failure, with rheumatic fever second. Although the basic physiology of cardiac decompensation is similar in adults and children, the presenting clinical picture may be somewhat different in the 2 groups.

We believe that infants and children with congestive failure should be treated vigorously, for we have the distinct impression that the mortality rate of these youngsters with severe heart disease has decreased appreciably since a more optimistic attitude prevails among parents and doctors about these problems. Vigorous use of anticongestive measures and antibiotics is worthwhile and results in many instances in the survival of an infant to an age when successful surgical repair is feasible. Certainly not all babies with congestive failure due to congenital, rheumatic, or other kind of heart disease can be salvaged. But surely the experience of the last few years has given us a much more optimistic outlook on this entire field. There are enough children attending school and enjoying life today who seemed at "death's door" in infancy to make us hesitate to give an unqualifiedly poor prognosis to almost any child in congestive failure. Similarly, we are more and more reluctant to suggest cardiac surgery as a dramatic emergency measure except in a few well-chosen cases. Intelligent medical management can salvage a large number of these children and allow them to survive to an age when relatively low surgical mortality may be offered.