Short-Term Outcomes of Acute Fulminant Myocarditis in Children

Abstract

Data on the clinical profile, echocardiographic findings, and outcome of acute fulminant myocarditis (AFM) in children from resource limited countries are limited. To study the clinical profile and short-term outcomes of children aged 2 months to 17 years with AFM managed with only supportive care. We enrolled all children admitted with AFM in our hospital from January 2009 to October 2010. Although the information on patients admitted from January 2009 to March 2010 were retrieved from the case records, data of children admitted from April 2010 were recorded prospectively. AFM was diagnosed based on clinical and echocardiographic criteria. We collected information regarding clinical course, treatment details, and echocardiography findings using a structured performa. All of the children, including those for whom baseline information was collected from the records, were followed-up prospectively to determine short-term outcomes. A total of 10 children, of whom 6 were male, presented with AFM. Their median age was 7.5 (interquartile range [IQR] 2 to 13) years, and the mean left-ventricular ejection fraction (LVEF) was 26% (SD 11.5). Of the 10 children, 9 were discharged, and 1 child died. At discharge, all children showed improvement in the symptoms, but only 4 had improvement in LV function on echocardiography. Factors associated with poor recovery of LV function at discharge were anasarca, low LVEF, and increased serum glutamate pyruvate transaminase levels at admission. One child had died at 2-month follow-up, and another child developed dilated cardiomyopathy at 15 months after discharge. Children with AFM had good immediate- and short-term outcomes even without the use of mechanical assist devices. Decreased LVEF at admission was found to be one of the most important determinants of poor immediate outcomes in these children.

Effects of the elective introduction of extracorporeal membrane oxygenation on outcomes in pediatric myocarditis cases

“…Pediatric myocarditis is a potentially life‐threatening disorder that can present as cardiogenic shock leading to end‐organ failure and death. Several myocarditis case series have shown that markers of end‐organ function are associated with death (Table ); indicating that adequate support for cardiorespiratory and end‐organ function forms the basis of treatment. Several previous studies have shown the efficacy of ECMO in managing pediatric myocarditis; however, once medical therapy limits have been reached, it is difficult to attempt transferring patients to a facility where ECMO management is available.…”

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

“…Acute fulminant myocarditis (AFM) is a rare and distinct clinical entity whose exact incidence is unknown; it constitutes approximately 10%-38% of all cases of acute myocarditis 1 , 2 , 3) . While the clinical presentation of myocarditis can be acute or chronic in adults, the majority of children with myocarditis present with acute or fulminant disease 4) .…”

“…Myocarditis results from inflammation of the heart muscle associated with apoptotic degeneration, with or without necrosis of adjacent myocytes 5) . Myocellular damage results in myocardial dysfunction leading to heart failure, and AFM is characterized by sudden onset of aggressive conditions such as, fatal arrhythmias, atrioventricular block (AV), severe congestive heart failure or cardiogenic shock following a flu-like illness 2 , 6) . Patients with AFM typically have a short viral prodrome with a distinct onset of symptoms (≤14 days) and rapid deterioration requiring hemodynamic support with inotropes and mechanical ventilation 6) .…”

Left ventricular end-diastolic dimension as a predictive factor of outcomes in children with acute myocarditis

“…2,[4][5][6] Studies performed in adults have shown that acute presentation and a small or normal left ventricular chamber at diagnosis are associated with a good prognosis versus a dilated left ventricle with arrhythmia. 7,8 In particular, some reports showed that clinical characteristics and outcome in children confined acute fulminant myocarditis; [9][10][11][12] however, data showing an association between mortality and left ventricular size in children are limited. The aims of this study were to assess the association between left ventricular dilatation and mortality in children with acute myocarditis, to identify factors that can predict mortality among children admitted to hospital with acute myocarditis, and to determine factors that are predictive of incomplete recovery in the survivor group.…”