BACKGROUND: Acute fulminant myocarditis is a life-threatening disease in children. A limited number of reports suggest that mechanical circulatory support (MCS) may be used to successfully bridge children with acute fulminant myocarditis to recovery or transplantation. We evaluated the effectiveness of MCS in children with myocarditis and identified risk factors associated with adverse outcomes. METHODS AND RESULTS: Between 2001 and 2009, 16 children were treated for myocarditis at our institution; each child received MCS provided by extracorporeal membrane oxygenation, ventricular assist device(s), or both. Of these patients, 75% (12/16) survived: 7 recovered ventricular function, and 5 underwent successful orthotopic heart transplantation. In patients who were bridged to recovery, mean left ventricular ejection fraction significantly improved from initiation to termination of MCS (20 ± 9.3% to 62 ± 5%; P = .0004). Viral pathogens were detected in 11 patients by polymerase chain reaction, and viral presence was associated with death or need for transplantation (P = .011). Upon histologic analysis, absence of viral infection and lack of myocardial inflammation were associated with recovery (P values .011 and .044, respectively). CONCLUSIONS: In children with acute fulminant and persistent myocarditis, MCS is a life-saving treatment strategy, particularly in the absence of viral infection.
BACKGROUND: Acute fulminant myocarditis is a life-threatening disease in children. A limited number of reports suggest that mechanical circulatory support (MCS) may be used to successfully bridge children with acute fulminant myocarditis to recovery or transplantation. We evaluated the effectiveness of MCS in children with myocarditis and identified risk factors associated with adverse outcomes. METHODS AND RESULTS: Between 2001 and 2009, 16 children were treated for myocarditis at our institution; each child received MCS provided by extracorporeal membrane oxygenation, ventricular assist device(s), or both. Of these patients, 75% (12/16) survived: 7 recovered ventricular function, and 5 underwent successful orthotopic heart transplantation. In patients who were bridged to recovery, mean left ventricular ejection fraction significantly improved from initiation to termination of MCS (20 ± 9.3% to 62 ± 5%; P = .0004). Viral pathogens were detected in 11 patients by polymerase chain reaction, and viral presence was associated with death or need for transplantation (P = .011). Upon histologic analysis, absence of viral infection and lack of myocardial inflammation were associated with recovery (P values .011 and .044, respectively). CONCLUSIONS: In children with acute fulminant and persistent myocarditis, MCS is a life-saving treatment strategy, particularly in the absence of viral infection.
Authors: Joseph R Casadonte; Mjaye L Mazwi; Katheryn E Gambetta; Hannah L Palac; Mary E McBride; Osama M Eltayeb; Michael C Monge; Carl L Backer; John M Costello Journal: Pediatr Cardiol Date: 2016-11-08 Impact factor: 1.655
Authors: Tae Hoon Kim; Yu Rim Shin; Young Sam Kim; Do Jung Kim; Hyohyun Kim; Hong Ju Shin; Aung Thein Htut; Han Ki Park Journal: Korean J Thorac Cardiovasc Surg Date: 2015-12-05
Authors: Sayed Nour; Jia Liu; Gang Dai; Daniel Carbognani; Daya Yang; Guifu Wu; Qinmei Wang; Juan Carlos Chachques Journal: Biomed Res Int Date: 2014-01-08 Impact factor: 3.411