Clinical features and short-term outcomes of pediatric acute fulminant myocarditis in a single center

Abstract

PurposeThe aims of this study were to document our single-center experience with pediatric acute fulminant myocarditis (AFM) and to investigate its clinical features and short-term outcomes.MethodsWe performed a retrospective chart review of all children <18 years old who were diagnosed with AFM between October 2008 and February 2013. Data about patient demographics, initial symptoms, investigation results, management, and outcomes between survivors and nonsurvivors were collected.ResultsSeventeen of 21 patients (80.9%) with myocarditis were diagnosed with AFM. Eleven patients (64.7%) survived to discharge, and 6 (35.3%) died. Electrocardiography on admission revealed dysrhythmia in 10 patients (58.8%); of these, all 7 patients with a complete atrioventricular block survived. Fractional shortening upon admission was significantly different between the survivors (16%) and nonsurvivors (8.5%) (P=0.01). Of the serial biochemical markers, only the initial brain natriuretic peptide (P=0.03) and peak blood urea nitrogen levels (P=0.02) were significantly different. Of 17 patients, 4 (23.5%) required medical treatment only. Extracorporeal membrane oxygenation (ECMO) was performed in 13 patients (76.5%); the survival rate in these patients was 53.8%. ECMO support was initiated >24 hours after admission in 4 of the 13 patients (30.7%), and 3 of those 4 patients (75%) died.ConclusionAFM outcomes may be associated with complete atrioventricular block upon hospital admission, left ventricular fractional shortening at admission, time from admission to the initiation of ECMO support, initial brain natriuretic peptide level, and peak blood urea nitrogen level.

Case Report: III° atrioventricular block due to fulminant myocarditis managed with non-invasive transcutaneous pacing

“…However, if it progresses there is the risk of acute cardiac failure, hemodynamic disturbances, and arrhythmias leading to significant morbidity and mortality. Mortality due to myocarditis for infants is more than 75%, whereas for children it is more than 25% 1, 5– 9 . There is no any specific clinical course and investigations to diagnose fulminant myocarditis.…”

A retrospective study: cardiac MRI of fulminant myocarditis in children—can we evaluate the short-term outcomes?

“…The favorable outcomes associated with complete AVB in FM and AM were also reported. Lee et al (2014) reported the short-term outcomes of FM children in a single center and found that all seven FM children with complete AVB on the initial EKG survived. The AM patients with complete AVB perform excellent survival rates (89–100%) and long-term outcomes (100%).…”

“…Despite the initial severe presentation, excellent short-term and long-term outcomes of FM with complete recovery of clinical manifestations and cardiac function have been found in the adult population (Felker et al, 2000; Ginsberg & Parrillo, 2013; McCarthy et al, 2000). While in the pediatric population, the outcomes of FM are controversial, with the mortality varied from 9.1% to 48.4% (Amabile et al, 2006; Saji et al, 2012; Lee et al, 2014). …”

Changes in serum cardiac myosin light chain 1 levels in children with fulminant myocarditis during continuous blood purification

“…Then, allergic reaction or autoimmune involvement can lead to further damage to cardiac muscle cells, resulting in localized or diffuse myocarditis. [5][6][7] The pathogenesis of anti-cardiac antibodies in post-viral autoimmune cases may start with direct viral-induced myocyte damage, with associated release of intracellular proteins.…”