With a complex interplay between the sympathetic and the parasympathetic neurotransmitters, norepinephrine and acetylcholine, vagal efferent activity leads to modulation of inflammation and cytokine generation within the spleen.20, 21, 22 Decades of work have established the relationship between inflammatory mediators such as TNF-α, IL-1 β, IL-6, C-reactive protein, etc, and HF pathophysiology. This evidence concerns the gene TNF and hydrops fetalis.