Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지

소아 심근염과 심근증

The myocarditis and cardiomyopathy in children

  • 길홍량 (충남대학교 의과대학 소아과학교실)
  • Kil, Hong Ryang (Department of Pediatrics, Chugnanm National University, College of Medicine)
  • 투고 : 2007.09.13
  • 심사 : 2007.10.25
  • 발행 : 2007.11.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Myocarditis represent an important condition encountered by general pediatricians & general practitioners. Its presentation is varied, and therefore a high index of suspicion must be maintained when the possibility of myocarditis is raised. A progression from viral myocarditis to dilated cardiomyopathy has long been hypothesized. Treatment is initially aimed at achieving hemodynamic stability and is largely supportive. There is currently little evidence to support the immunomodulatory or specific antiviral therapies. Pediatric cardiomyopathies are a heterogeneous group of disorders with diverse genetic, infectious, mitochodrial and metabolic etiologies. The timing and severity of presentation vary according to cardiomyopathy type as well as genetic and ethnic factors. The behavior of specific cardiomyopathies can be predicted by morphological and functional attributes, as well as underlying patient characteristics.

키워드

참고문헌

  1. Grogan M, Redfield MM, Bailey KR, Reeder GS, Gersh RJ, Edwards WD, et al. Long-term outcome of patients with biopsy-proved myocarditis: comparison with idiopathic dilated cardiomyopathy. J Am Coll Cardiol 1995;26:80-4 https://doi.org/10.1016/0735-1097(95)00148-S
  2. Doolan A, Langlois N, Semsarian C. Causes of sudden cardiac death in young Australians. Med J Aust 2004;180: 110-2
  3. Wojnicz R, Nowalany-Kozielska E, Wodniecki J. SzczurekKatanski S, Nozynski J, Zembala M, et al. Immunohistological diagnosis of myocarditis: potential role of sarcolemmal induction of the MHC and ICAM-1 in the detection of autoimmune mediated myocyte injury. Eur Heart J 1998;19:156472
  4. Pauschinger M, Bowles NE, Fuentes-Garcia FJ, Pham V, Kuhl U, Schwimmbeck PL, et al. Detection of adenoviral genome in the myocardium of adult patients with idiopathic left ventricular dysfunction. Circulation 1999;99:1348-54 https://doi.org/10.1161/01.CIR.99.10.1348
  5. Bowles NE, Ni J, Kearney DL, Pauschinger M, Schultheiss HP, McCarthy R, et al. Detection of viruses in myocardial tissues by polymerase chain reaction: evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol 2003;42:466-72 https://doi.org/10.1016/S0735-1097(03)00648-X
  6. Panhoweit S, Lamparter S, Schoppet M, Maisch B. Parvo virus B19 genome in endomyocardial biopsy specimens. Circulation 2004;109:e179 https://doi.org/10.1161/01.CIR.0000124881.00415.59
  7. Hofman P, Drici MD, Gibelin P, Michiels JF, Thyss A. Prevalence of toxoplasma myocarditis in patients with the acquired immunodeficiency syndrome. Br Heart J 1993;70: 376-81 https://doi.org/10.1136/hrt.70.4.376
  8. Pulerwitz TC, Cappola TP, Felker GM, Hare JM, Baughman KL, Kasper EK. Mortality in primary and secondary myocarditis. Am Heart J 2004;147:746-50 https://doi.org/10.1016/j.ahj.2003.10.029
  9. Webb JG, Butany J, Langer G, Scott G, Liu PP. Myocarditis and myocardial hemorrhage associated with thrombotic thrombocytopenic purpura. Arch Intern Med 1990;150:1535-7 https://doi.org/10.1001/archinte.150.7.1535
  10. Liu PP, Mason JW, Advances in the understanding of myocarditis. Circulation 2001;104:1076-82 https://doi.org/10.1161/hc3401.095198
  11. Kawai C. From myocarditis to cardiomyopathy: mechanisms of inflammation and cell death: learning from the past for the future. Circulation 1999;99:1091-100. https://doi.org/10.1161/01.CIR.99.8.1091
  12. Mason JW, O' Connell JB, Herskowitz A, Rose NR, McManus BM, Billingham ME, et al. For the Myocarditis Treatment Trial Investigators. A clinical trial of immunosuppressive therapy for myocarditis. N Engl J Med 1995; 333:269-75 https://doi.org/10.1056/NEJM199508033330501
  13. Baboonian C, Treasure T. Meta-analysis of the association of enteroviruses with human heart disease. Heart 1997;78:539-43
  14. Feldman AM, McNamara D. Myocarditis. N Engl J Med 2000;343:1388-98 https://doi.org/10.1056/NEJM200011093431908
  15. Dec GW, Palacios IF, Fallon JT, Aretz HT, MillsJ, Lee DC, et al. Active myocarditis in the spectrum of acute dilated cardiomyopathies: clinical features, histologic correlates, and clinical outcome. N Engl J Med 1985;312:885-90 https://doi.org/10.1056/NEJM198504043121404
  16. Lieberman EB, Hutchins GM, Herskowitz A, Rose NR, Baughman KL. Clinicopathologic description of myocarditis. J Am Coll Cardiol 1991;18:1617-26 https://doi.org/10.1016/0735-1097(91)90493-S
  17. Dec GW, Waldman H, Southern J, Fallon JT, Hutter AM, Palacios I. Viral myocarditis mimicking acute myocardial infarction. J Am Coll Cardiol 1992;20:85-9 https://doi.org/10.1016/0735-1097(92)90141-9
  18. Sarda L, Colin P, Boccara F, Daou D, Lebtahi R, Faraggi M, et al. Myocarditis in patients with clinical presentation of myocardial infarction and normal coronary angiograms. J Am Coll Cardiol 2001;37:786-92 https://doi.org/10.1016/S0735-1097(00)01201-8
  19. Cooper LT, Berry GJ, Shabetai R. For the Multicenter Giant Cell Myocarditis Study Group Investigators. Idiopathic giantcell myocarditis: natural history and treatment. N Engl J Med 1997;336:1860-6 https://doi.org/10.1056/NEJM199706263362603
  20. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. ACC/ AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). Circulation 2005;112:1825-52 https://doi.org/10.1161/CIRCULATIONAHA.105.167587
  21. Shanes JG, Ghali J, Billingham ME, Ferrans VJ, Fenoglio JJ, Edwards WD, et al. Interobserver variability in the pathologic interpretation of endomyocardial biopsy results. Circulation 1987;75:401-5 https://doi.org/10.1161/01.CIR.75.2.401
  22. Cassling RS, Linder J, Sears TD, Waller BF, RogIer WC, Wilson JE, et al. Quantitative evaluation of inflammation in biopsy specimens from idiopathically failing or irritable hearts: experience in 80 pediatric and adult patients. Am Heart J 1985;110:713-20 https://doi.org/10.1016/0002-8703(85)90447-8
  23. Lieback E, Hardouin I, Meyer R, Bellach J. Hetzer R. Clinical value of echo cardiographic tissue characterization in the diagnosis of myocarditis. Eur Heart J 1996;17:135-42 https://doi.org/10.1093/oxfordjournals.eurheartj.a014671
  24. Magnani JW, Dec W. Myocarditis-current trends in diagnosis and treatment. Circulation 2006;113:876-90 https://doi.org/10.1161/CIRCULATIONAHA.105.584532
  25. McCarthy RE, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Hare JM, et al. Long-term outcome of fulminant myocarditis as compared with acute (non-fulminant) myocarditis. N Engl J Med 2000;342:690-5 https://doi.org/10.1056/NEJM200003093421003
  26. Grogan M, Redfield MM, Bailey KR, Reeder GS, Gersh RJ, Edwards WD, et al. Long-term outcome of patients with biopsy-proved myocarditis: comparison with idiopathic di1ated cardiomyopathy. J Am Coll Cardiol 1995;26:80-4 https://doi.org/10.1016/0735-1097(95)00148-S
  27. Why HJ, Meany BT, Richardson PJ, Olsen EG, Bowles NE, Cunningham L, et al. Clinical and prognostic significance of detection of enteroviral RNA in the myocardium of patients with myocarditis or dilated cardiomyopathy. Circulation 1994;89:2582-9 https://doi.org/10.1161/01.CIR.89.6.2582
  28. Dec GW, Palacios I, Yasuda T, Fallon JT, Khaw BA, Strauss HW, et al. Antimyosin antibody cardiac imaging: its role in the diagnosis of myocarditis. J Am Coll Cardiol 1990;16:97-104 https://doi.org/10.1016/0735-1097(90)90463-Y
  29. Parrillo JE, Cunnion RE, Epstein SE, Parker MM, Saffredini AF, Brenner M, et al. A prospective, randomized, controlled trial of prednisone for dilated cardiomyopathy. N Engl J Med 1989;321:1061-68 https://doi.org/10.1056/NEJM198910193211601
  30. McNamara DM, Holubkov R, Starling RC, Dec GW, Loh E, Torre- Amione G, et al. Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy. Circulation 2001;103:2254-59 https://doi.org/10.1161/01.CIR.103.18.2254
  31. Miric M, Vasiljevic J, Bojic M, Popovic Z, Keserovic N, Pesic M. Long-term follow up of patients with dilated heart muscle disease treated with human leucocytic interferon alpha or thymic hormones: initial results. Heart 1996;75:596-601 https://doi.org/10.1136/hrt.75.6.596
  32. Weintraub RG, Nugent AW, Daubeney PE. Pediatric cardiomyopathy: The Australian experience. Progress in Pediatric cardiology 2007;23:17-24 https://doi.org/10.1016/j.ppedcard.2007.05.006
  33. Arola A, Jokinen E, Ruuskanen O. Epidemiology of idiopathic cardiomyopathies in children and adolescents: a nationwide study in Finland. Am J Epidemiol 1997;146:385-93 https://doi.org/10.1093/oxfordjournals.aje.a009291
  34. Lipshultz SE, Sleeper LA, Towbin JA. The incidence of pediatric cardiomyopathy in two regions of the United States. N Engl J Med 2003;348:1647-55 https://doi.org/10.1056/NEJMoa021715
  35. Nugent A W, Daubeney PEF, Chondros. The epidemiology of childhood cardiomyopathy in Australia. N Engl J Med 2003;348:1639-46 https://doi.org/10.1056/NEJMoa021737
  36. Towbin JA, Lowe AM, Colan SD, Sleeper LA, Orav EJ, Clunie S, et al. Incidence, cause, and outcomes of dilated cardiomyopathy in children. JAMA 2006;296:1867-76 https://doi.org/10.1001/jama.296.15.1867
  37. Triska AE, Trinkaus K, Chen SC. Improved outcomes of pediatric dilated cardiomyopathy with utilization of heart transplantation. J Am Coll Cardiol 2004;44:391-7 https://doi.org/10.1016/j.jacc.2004.04.035
  38. Braunwald E, Seidman CE, Sigwart U. Contemporary evaluation and management of hypertrophic cardiomyopathy. Circulation 2002;106:1312-6 https://doi.org/10.1161/01.CIR.0000030314.11999.6A
  39. Pollick C. Muscular sub aortic stenosis: hemodynamic and clinical improvement after disopyramide. N Engl J Med 1982;307:997-9 https://doi.org/10.1056/NEJM198210143071607
  40. Schulte HD, Borisov K, Gams E, Gramsch-Zabel H, Losse B, Schwartzkopff B. Management of symptomatic hypertrophic obstructive cardiomyopathy-long-term results after surgical therapy. Thorac Cardiovasc Surg 1999;47:213-8 https://doi.org/10.1055/s-2007-1013146