Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Lee, Eun Young (Department of Pediatrics, Good Gang-An Hospital) ;
  • Lee, Hae Lyoung (Department of Pediatrics, Good Gang-An Hospital) ;
  • Kim, Hyung Tae (Heart Center, Pusan National University Children's Hospital) ;
  • Lee, Hyoung Doo (Heart Center, Pusan National University Children's Hospital) ;
  • Park, Ji Ae (Department of Pediatrics, Good Gang-An Hospital)
  • Received : 2014.03.19
  • Accepted : 2014.08.20
  • Published : 2014.11.10
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The 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. Methods: We 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. Results: Seventeen 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. Conclusion: AFM 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.

Keywords

References

  1. Amabile N, Fraisse A, Bouvenot J, Chetaille P, Ovaert C. Outcome of acute fulminant myocarditis in children. Heart 2006;92:1269-73.
  2. Sankar J, Khalil S, Jeeva Sankar M, Kumar D, Dubey N. Short-term outcomes of acute fulminant myocarditis in children. Pediatr Cardiol 2011;32:885-90.
  3. McCarthy RE 3rd, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Hare JM, et al. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med 2000;342:690-5.
  4. Tschope C, Bock CT, Kasner M, Noutsias M, Westermann D, Schwimmbeck PL, et al. High prevalence of cardiac parvovirus B19 infection in patients with isolated left ventricular diastolic dysfunction. Circulation 2005;111:879-86.
  5. Esfandiarei M, McManus BM. Molecular biology and pathogenesis of viral myocarditis. Annu Rev Pathol 2008;3:127-55.
  6. Teele SA, Allan CK, Laussen PC, Newburger JW, Gauvreau K, Thiagarajan RR. Management and outcomes in pediatric patients presenting with acute fulminant myocarditis. J Pediatr 2011;158:638-643.e1.
  7. Brown KL, Ichord R, Marino BS, Thiagarajan RR. Outcomes following extracorporeal membrane oxygenation in children with cardiac disease. Pediatr Crit Care Med 2013;14(5 Suppl 1):S73-83.
  8. del Nido PJ. Extracorporeal membrane oxygenation for cardiac support in children. Ann Thorac Surg 1996;61:336-9.
  9. Hsu KH, Chi NH, Yu HY, Wang CH, Huang SC, Wang SS, et al. Extracorporeal membranous oxygenation support for acute fulminant myocarditis: analysis of a single center's experience. Eur J Cardiothorac Surg 2011;40:682-8.
  10. Rajagopal SK, Almond CS, Laussen PC, Rycus PT, Wypij D, Thiagarajan RR. Extracorporeal membrane oxygenation for the support of infants, children, and young adults with acute myocarditis: a review of the Extracorporeal Life Support Organization registry. Crit Care Med 2010;38:382-7.
  11. Wilmot I, Morales DL, Price JF, Rossano JW, Kim JJ, Decker JA, et al. Effectiveness of mechanical circulatory support in children with acute fulminant and persistent myocarditis. J Card Fail 2011;17:487-94.
  12. Freedman SB, Haladyn JK, Floh A, Kirsh JA, Taylor G, Thull-Freedman J. Pediatric myocarditis: emergency department clinical findings and diagnostic evaluation. Pediatrics 2007;120:1278-85.
  13. Doolan A, Langlois N, Semsarian C. Causes of sudden cardiac death in young Australians. Med J Aust 2004;180:110-2.
  14. Fleming GM, Gurney JG, Donohue JE, Remenapp RT, Annich GM. Mechanical component failures in 28,171 neonatal and pediatric extracorporeal membrane oxygenation courses from 1987 to 2006. Pediatr Crit Care Med 2009;10:439-44.
  15. Thourani VH, Kirshbom PM, Kanter KR, Simsic J, Kogon BE, Wagoner S, et al. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in pediatric cardiac support. Ann Thorac Surg 2006;82:138-44.
  16. Saji T, Matsuura H, Hasegawa K, Nishikawa T, Yamamoto E, Ohki H, et al. Comparison of the clinical presentation, treatment, and outcome of fulminant and acute myocarditis in children. Circ J 2012;76:1222-8.
  17. Lieberman EB, Hutchins GM, Herskowitz A, Rose NR, Baughman KL. Clinicopathologic description of myocarditis. J Am Coll Cardiol 1991;18:1617-26.
  18. Baraldi-Junkins C, Levin HR, Kasper EK, Rayburn BK, Herskowitz A, Baughman KL. Complications of endomyocardial biopsy in heart transplant patients. J Heart Lung Transplant 1993;12(1 Pt 1):63-7.
  19. Press S, Lipkind RS. Acute myocarditis in infants. Initial presentation. Clin Pediatr (Phila) 1990;29:73-6.
  20. Miyake CY, Teele SA, Chen L, Motonaga KS, Dubin AM, Balasubramanian S, et al. In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. Am J Cardiol 2014;113:535-40.
  21. Al-Biltagi M, Issa M, Hagar HA, Abdel-Hafez M, Aziz NA. Circulating cardiac troponins levels and cardiac dysfunction in children with acute and fulminant viral myocarditis. Acta Paediatr 2010;99:1510-6.
  22. Felker GM, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Baughman KL, et al. Echocardiographic findings in fulminant and acute myocarditis. J Am Coll Cardiol 2000;36:227-32.
  23. Duncan BW, Bohn DJ, Atz AM, French JW, Laussen PC, Wessel DL. Mechanical circulatory support for the treatment of children with acute fulminant myocarditis. J Thorac Cardiovasc Surg 2001;122:440-8.
  24. Chen YS, Yu HY, Huang SC, Chiu KM, Lin TY, Lai LP, et al. Experience and result of extracorporeal membrane oxygenation in treating fulminant myocarditis with shock: what mechanical support should be considered first? J Heart Lung Transplant 2005;24:81-7.
  25. Hintz SR, Benitz WE, Colby CE, Sheehan AM, Rycus P, Van Meurs KP, et al. Utilization and outcomes of neonatal cardiac extracorporeal life support: 1996-2000. Pediatr Crit Care Med 2005;6:33-8.

Cited by

  1. A retrospective study: cardiac MRI of fulminant myocarditis in children—can we evaluate the short-term outcomes? vol.4, pp.None, 2014, https://doi.org/10.7717/peerj.2750
  2. Preventing pediatric cardiomyopathy: a 2015 outlook vol.14, pp.3, 2014, https://doi.org/10.1586/14779072.2016.1129899
  3. Extracorporeal life support can be a first-line treatment in children with acute fulminant myocarditis vol.23, pp.2, 2014, https://doi.org/10.1093/icvts/ivw114
  4. Biomarkers in Pediatric Cardiac Critical Care : vol.17, pp.8, 2014, https://doi.org/10.1097/pcc.0000000000000778
  5. Left ventricular end-diastolic dimension as a predictive factor of outcomes in children with acute myocarditis vol.27, pp.3, 2017, https://doi.org/10.1017/s1047951116000706
  6. ECMO as an effective rescue therapeutic for fulminant myocarditis complicated with refractory cardiac arrest vol.13, pp.None, 2014, https://doi.org/10.2147/tcrm.s147845
  7. Case Report: III° atrioventricular block due to fulminant myocarditis managed with non-invasive transcutaneous pacing vol.7, pp.None, 2018, https://doi.org/10.12688/f1000research.14000.2
  8. Successful treatment of fulminant myocarditis in an adult in emergency department : A case report vol.98, pp.49, 2014, https://doi.org/10.1097/md.0000000000018292
  9. Clinical characteristics and treatment effects of astragalus injection in non-pediatric patients with acute fulminant myocarditis vol.99, pp.48, 2014, https://doi.org/10.1097/md.0000000000023062
  10. Risk factors for adverse cardiac events in adults with fulminant myocarditis during hospitalization vol.8, pp.2, 2014, https://doi.org/10.12998/wjcc.v8.i2.255
  11. Pediatric Acute Myocarditis With Short-Term Outcomes and Factors for Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Cohort Study in Vietnam vol.8, pp.None, 2014, https://doi.org/10.3389/fcvm.2021.741260
  12. The use of extracorporeal membrane oxygenation in children with acute fulminant myocarditis vol.64, pp.5, 2014, https://doi.org/10.3345/cep.2020.00836
  13. Bloqueo auriculoventricular completo asociado a infección por virus respiratorio sincitial: presentación de un caso y revisión de la literatura vol.94, pp.6, 2021, https://doi.org/10.1016/j.anpedi.2020.06.009
  14. Complete atrioventricular block associated with respiratory syncytial virus: Presentation of a case and a literature review vol.94, pp.6, 2014, https://doi.org/10.1016/j.anpede.2020.06.013
  15. Brain Injury in Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach vol.41, pp.4, 2021, https://doi.org/10.1055/s-0041-1726284