Endomyocardial biopsy safety and clinical yield in pediatric myocarditis: An Italian perspective

Brighenti, Maurizio; Donti, Andrea; Gagliardi, Maria Giulia; Maschietto, Nicola; Marini, Davide; Lombardi, M.; Vairo, Ugo; Agnoletti, Gabriella; Milanesi, Ornella; Pongiglione, Giacomo; Bonvicini, Marco

doi:10.1002/ccd.26319

Cited by 24 publications

(25 citation statements)

References 19 publications

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“…It is worth mentioning 2 caveats in the diagnosis of the present case. First, endomyocardial biopsy is considered the gold standard for diagnosis, but the biopsy has limitations because of its invasiveness and low sensitivity due to patchiness of lesions 14) . When the biopsy is not possible, cardiac MRI is increasingly used to diagnose the entity 15) .…”

Section: A B Discussionmentioning

confidence: 99%

Acute myocarditis associated with non-typhoidal Salmonella gastroenteritis

Sw¹,

Son²,

Moon³

et al. 2019

Pediatr Emerg Med J

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Acute myocarditis is clinically rare in children, but poses a significant risk for morbidity and mortality. Children with myocarditis show a wide variety of clinical manifestations ranging from subclinical myocarditis to heart failure, hemodynamic compromise, arrhythmia, and even sudden death. Salmonella species are associated with clinical presentations including gastroenteritis, enteric fever, bacteremia, and extra-intestinal focal infections. Non-typhoidal Salmonella infections usually cause self-limiting gastroenteritis, but are rarely associated with myocarditis. In this report, we present a case of myocarditis associated with Salmonella serogroup B gastroenteritis in a previously healthy 15-year-old boy.

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Section: A B Discussionmentioning

confidence: 99%

Acute myocarditis associated with non-typhoidal Salmonella gastroenteritis

Sw¹,

Son²,

Moon³

et al. 2019

Pediatr Emerg Med J

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“…Выполнение эндомио-кардиальной биопсии при остром/фульминантном миокардите сопровождается осложнениями с часто-той до 15,5%, а у младенцев -до 31,2% даже в круп-ных европейских кардиологических центрах [9], и эта процедура недоступна для большинства региональ-ных детских госпиталей. По этим причинам диагно-стика миокардита проводилась нами неинвазивны-ми методами.…”

Section: Discussionunclassified

“…Эндоми-окардиальная биопсия на сегодня считается един-ственным достоверным маркером для дифференци-альной диагностики миокардита и невоспалительной кардиомиопатии, а также для этиологической вери-фикации при миокардите, причем доля ложноотри-цательных результатов снизилась в последние годы ввиду расширения процедуры (образцы из правого и левого желудочков) [1,2,8]. Однако применение эндомиокардиальной биопсии у детей, особенно в возрасте до одного года при остром миокардите проблематично ввиду того, что частота осложнений достигает 31,2% [9] и в России это исследование осу-ществляют единичные центры.…”

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Experience in the Observation of Acute and Fulminant Myocarditis in Children

Bregel¹,

Субботин²,

Белозеров³

et al. 2017

Ross. vestn. perinatol. pediatr.

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DOI: 10.21508/1027DOI: 10.21508/ -4065-2017 The results of observation of 17 patients aged 2 months to 16 years with acute and fulminant myocarditis (FM) were analyzed. Patients were observed in the period 2013-2016. Diagnostics used clinical data, laboratory and instrumental studies. Of 17 patients, acute myocarditis was diagnosed in 14 children, fulminant in 3. Therapy included, first of all, measures for the treatment of heart failurediuretics (furosemide, verospiron, triampur), angiotensin converting enzyme (ACE) inhibitors (captopril), beta-blockers, digoxin inotropic agents. Intravenous human immunoglobulin was administered at a dose of 1-2 g/kg/course in 5 of 17 (29.4%) patients. When the pathogen was verified, specific antiviral therapy (acyclovir, ganciclovir, cymevene) was administered in a standard mode. Immunosuppressive therapy (prednisolone, delagil) was prescribed for two of them. Nonsteroidal anti-inflammatory drugs (ibuprofen, diclofenac) was obtained in children with acute myocarditis duration of over 2 weeks (13 children) prior to 2016. Nonsteroidal antiinflammatory drugs were not administered to hemodynamically unstable patients, regardless of the time period of observation. Overall, 16 out of 17 (94.4%) patients recovered with apparent regression of signs of myocarditis on the background of treatmentthe symptoms of acute heart failure and cardiogenic shock were treated, and then manifestations of chronic congestive heart failure gradually decreased. 1 (5,6%) child with fulminant myocarditis died. After 6 months to 3 years, 14 children were observed. Follow-up within 6 months to 3 years showed that the diameter of the left ventricle normalized in 10 out of 14 (71.4%). Two out of 14 children (14.3%) formed postmyocardial dilated cardiomyopathy. Key words: children, myocarditis acute and fulminant, treatment, outcome, prognosis.For citation : Bregel L.V., Subbotin V.M., Belozerov Yu.M., Efremova O.S., Tolstikova T.V., Matyunova A.E., Mikhalevich I.M. Experience in the observation of acute and fulminant myocarditis in children. Ros Vestn Perinatol i Pediatr 2017; 62:(6): 69-76 (in Russ).

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“…Despite CMR imaging represents the gold standard procedure in order to diagnose myocarditis [17], in this child it was not performed because it would have not changed the clinical management, moreover exposing healthcare staff to a further risk of infection [6]; CMR imaging was performed during outpatient follow-up for prognostic evaluation. Furthermore, endomyocardial biopsy was not performed because it is not routinely executed for myocarditis diagnosis in pediatric patients and it is usually performed in critical cases unresponsive to therapy [18].…”

Section: Limitationsmentioning

confidence: 99%

Myocarditis Associated with Coronavirus Disease 2019 (COVID-19) in a Pediatric Patient

Salvini¹,

Giuli²,

Stacul³

et al. 2020

AID

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Viral infection is one of the most important causes of myocarditis both in adult and pediatric age. We describe acute myocarditis due to SARS-CoV-2 infection in an otherwise healthy 12-years-old Caucasian boy. He was admitted because of a history of 2 days of fever, dry cough, diarrhea, abdominal pain and fatigue. In spite of a family history of COVID-19 patient strict contact, a first nasopharyngeal swab for SARS-CoV-2 RNA resulted negative. After 4 days, his clinical condition evolved, with the onset of interstitial pneumonia, as documented by chest tomography and tachycardia. Blood analysis showed an NTproBNP and TnT increasing, transthoracic echocardiography revealed normal left ventricle (LV) dimension, altered myocardial texture, diffuse hypokinesis and impaired left ventricular function. A nasopharyngeal swab tested positive for SARS-CoV-2 infection at day 6 after admission. Heart failure conventional treatment associated with heparin, glucocorticoids and Remdesivir were administered with progressive improvement of clinical and instrumental conditions. No residual heart damage was documented during the following 3 monthes cardiological outpatient follow-up. Although COVID-19 infection has a milder course of disease in children than in adults, severe forms of the disease may occur and myocarditis should be carefully considered in the pediatric age.

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Endomyocardial biopsy safety and clinical yield in pediatric myocarditis: An Italian perspective

Cited by 24 publications

References 19 publications

Acute myocarditis associated with non-typhoidal Salmonella gastroenteritis

Acute myocarditis associated with non-typhoidal Salmonella gastroenteritis

Experience in the Observation of Acute and Fulminant Myocarditis in Children

Myocarditis Associated with Coronavirus Disease 2019 (COVID-19) in a Pediatric Patient

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