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Clinical outcomes of acute myocarditis in childhood
K J Lee1, B W McCrindle, D J Bohn
1Division of Cardiology, Hospital for Sick Children, 555 University Avenue,Toronto, Ontario M5G 1X8, Canada.
Insights
Pediatric lymphocytic myocarditis shows good outcomes with immunosuppression, including high survival rates and recovery of heart function. Most survivors experience no symptoms or activity restrictions after treatment.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Immunology
Background:
- Lymphocytic myocarditis is a serious condition in children.
- Acute heart failure is a common presentation.
- Outcomes data for pediatric lymphocytic myocarditis are limited.
Purpose of the Study:
- To describe clinical outcomes in pediatric patients with lymphocytic myocarditis.
- To evaluate survival, cardiac transplantation rates, and functional recovery.
- To assess the long-term impact on cardiac function and arrhythmias.
Main Methods:
- Retrospective review of 36 pediatric patients with histologically confirmed lymphocytic myocarditis.
- Data collected between November 1984 and February 1998.
- Analysis of survival, cardiac transplantation, ventricular function recovery, and arrhythmias.
Main Results:
- 86% survival at one month, 79% at two years, with 6 deaths overall.
- 29 survivors (out of 36) achieved recovery of left ventricular ejection fraction (>55%) within a median of 2.8 months.
- No patients required antiarrhythmic treatment; survivors had no cardiac symptoms or activity restrictions.
Conclusions:
- Pediatric lymphocytic myocarditis treated with immunosuppression is associated with favorable clinical outcomes.
- Excellent survival and recovery of ventricular function are achievable.
- Absence of significant arrhythmias and long-term cardiac morbidity is common.
Objective:
To describe clinical outcomes of a paediatric population with histologically confirmed lymphocytic myocarditis.
Design:
A retrospective review between November 1984 and February 1998.
Setting:
A major paediatric tertiary care hospital.
Patients:
36 patients with histologically confirmed lymphocytic myocarditis.
Main Outcome Measures:
Survival, cardiac transplantation, recovery of ventricular function, and persistence of dysrhythmias.
Results:
Freedom from death or cardiac transplantation was 86% at one month and 79% after two years. Five deaths occurred within 72 hours of admission, and one late death at 1.9 years. Extracorporeal membrane oxygenation support was used in four patients, and three patients underwent heart replacement. 34 patients were treated with intravenous corticosteroids. In the survivor/non-cardiac transplantation group (n = 29), the median follow up was 19 months (range 1.2-131.6 months), and the median period for recovery of a left ventricular ejection fraction to > 55% was 2.8 months (range 0-28 months). The mean (SD) final left ventricular ejection and shortening fractions were 66 (9)% and 34 (8)%, respectively. Two patients had residual ventricular dysfunction. No patient required antiarrhythmic treatment. All survivors reported no cardiac symptoms or restrictions in physical activity.
Conclusions:
Our experience documents good outcomes in paediatric patients presenting with acute heart failure secondary to acute lymphocytic myocarditis treated with immunosuppression. Excellent survival and recovery of ventricular function, with the absence of significant arrhythmias, continued cardiac medications, or restrictions in physical activity were the normal outcomes.