[Plasticity of the myocardium in pediatric cardiology]

The phenotypic adaptation of the myocardium to mechanical overload is a well known concept. The changes that occur into the myocardial structure in heart failure lead to new therapeutical approaches, particularly the use of ACE inhibitors in the treatment of dilated cardiomyopathies in order to prevent myocardial remodeling. In the hypoplastic left heart syndrome or in pulmonary atresia-intact septum, the pathogenetic process is supposed to be abnormal intra-cardiac blood flow during fetal life inducing abnormal cardiac remodeling. When the left ventricle ejects into the pulmonary circulation (double discordance, atrial repair of transposition of the great arteries), the surgical repair that consists to replace the left ventricule in the systemic circuit is based on the concept of ventricular remodeling and plasticity.