The Immune and Inflammatory Basis of Acquired Pediatric Cardiac Disease

Figures

• 

  Figure 1. Overview of acquired pediatric heart disease. Acquired pediatric heart diseases can arise as a reaction to various stresses, including flow differences, structural changes, or pathogens. The development of many of these conditions has an immune or inflammatory trigger that causes remodeling of the cardiac structures or activation of native immune cells. Many of these conditions are progressive, leading to long-term complications such as valve damage, fibrosis, and adverse cardiac remodeling.

• 

  Figure 2. Pathogen-induced acquired pediatric heart disease. Some pediatric cardiac conditions have well-defined immune causes in response to an infectious organism. (A) In RHD, biomimicry, in which antibodies against Group A streptococcal bacteria cross react with cardiac proteins, causes cardiac damage, specifically mitral valve fibrosis and subsequent stenosis. (B) The endothelium can also become directly infected, as seen in endocarditis, in which flow induced damage creates a nidus for bacterial seeding.

• 

  Figure 3. Inflammation-mediated pediatric cardiac disease. In addition to a cellular response, a molecular inflammatory response can lead to pediatric heart disease or its complications. (A) In myocarditis, inflammation of the cardiac muscle can cause reactionary remodeling, in some cases leading to DCM. (B) Remodeling can also be seen in shear stress induced inflammation, which propagates a pro-fibrotic environment in HCM or DSS.

• 

  Figure 4. Vascular inflammation-mediated pediatric cardiovascular disease. Inflammation following infection can lead to vascular damage and cardiac pathology. Inflammation and an associated immune response within the vasculature can cause vascular structural damage, as seen in coronary aneurysms in Kawasaki disease (A), which reduces blood flow in the coronary arteries and predisposes individuals to premature MI. In Multisystem Inflammatory Syndrome in Children (B), systemic inflammation causes damage to various organ systems, including targeting vascular and cardiac tissues to cause myocarditis, coronary artery aneurysms, and heart failure.