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Therapy for pediatric myocarditis

Charles E Canter1

  • 1Department of Pediatrics, Division of Cardiology, Washington University School of Medicine, St. Louis, MO 63110, USA. canter@kids.wustl.edu

Current Treatment Options in Cardiovascular Medicine
|September 6, 2005
PubMed

Insights

Pediatric myocarditis, often causing congestive heart failure in children, requires aggressive supportive care, especially for severe cases. While some therapies show promise, their routine use is debated due to spontaneous recovery and lack of proven benefit in rigorous trials.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Pathology
  • Critical Care Medicine

Background:

  • Pediatric myocarditis frequently presents as acute or subacute congestive heart failure in healthy children.
  • Fulminant myocarditis, a severe form, demonstrates a high recovery rate with intensive supportive care, including mechanical circulatory support.
  • Subacute heart failure management in pediatric myocarditis primarily relies on supportive care.

Purpose of the Study:

  • To review the current understanding and therapeutic approaches for pediatric myocarditis.
  • To evaluate the safety and efficacy of immunosuppressive and immunomodulating therapies in pediatric myocarditis.
  • To discuss the challenges in translating findings from uncontrolled pediatric studies to routine clinical practice.

Main Methods:

  • Review of existing pediatric studies on myocarditis treatment.
  • Analysis of data regarding supportive care, immunosuppressive therapy, and intravenous gamma globulin.
  • Consideration of evidence from adult myocarditis trials regarding immunosuppressive therapies.

Main Results:

  • Uncontrolled pediatric studies suggest immunosuppressive and immunomodulating therapies may be safe and beneficial.
  • High rates of spontaneous improvement in myocarditis with supportive care complicate treatment evaluation.
  • Blinded, randomized, placebo-controlled trials in adults have not demonstrated clear benefits for these therapies.

Conclusions:

  • Aggressive supportive care, including mechanical support for fulminant cases, is crucial for pediatric myocarditis.
  • The role of immunosuppressive and immunomodulating therapies in routine pediatric myocarditis treatment remains uncertain.
  • Heart transplantation is reserved for children with myocarditis and intractable severe heart failure.

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