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Children may survive severe myocarditis with prolonged use of biventricular assist devices
B Stiller1, I Dähnert, Y G Weng
1Department of Paediatric Cardiology, German Heart Institute, Augustenburgerplatz 1, 13353 Berlin, Germany.
Insights
Acute myocarditis with cardiogenic shock is serious. Biventricular assist devices (BVAD) offer life-saving support for children, aiding heart recovery or enabling heart transplantation.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Acute myocarditis can lead to severe cardiogenic shock and multiorgan dysfunction in children.
- Aggressive medical management is often insufficient for pediatric patients with acute myocarditis and ventricular failure.
Observation:
- Four previously healthy children (aged 1-6 years) presented with acute myocarditis, ventricular failure, and low cardiac output.
- Biventricular assist devices (BVAD) were surgically implanted to provide mechanical circulatory support.
Findings:
- Three children demonstrated significant myocardial recovery, allowing for the withdrawal of BVAD support within 21 days, achieving full cardiac function restoration.
- One child did not achieve myocardial recovery after 20 days of support and successfully underwent orthotopic heart transplantation.
Implications:
- Prolonged circulatory support using BVAD is a viable and effective strategy for pediatric patients with acute myocarditis.
- BVAD serves as a crucial bridge-to-recovery or bridge-to-transplant option in severe pediatric heart failure cases.
Abstract:
The outcome of acute myocarditis with cardiogenic shock is poor. In some children in whom aggressive medical treatment fails, artificial replacement of heart function may offer lifesaving support until the myocardium has recovered. Four previously healthy children (three boys aged 4, 6, and 1 years; one girl aged 5) developed acute myocarditis with ventricular failure and multiorgan dysfunction caused by low cardiac output. Biventricular assist devices (BVAD) were implanted for prolonged support. In three children cardiac function improved and after up to 21 days mechanical support could be withdrawn. They had full recovery of heart function. In the fourth patient there was no myocardial recovery after a period of 20 days. He underwent orthotopic heart transplantation with an uneventful postoperative course. Prolonged circulatory support with BVAD is an effective method for bridging until cardiac recovery or transplantation in children.