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Effectiveness of mechanical circulatory support in children with acute fulminant and persistent myocarditis

Ivan Wilmot1, David L S Morales, Jack F Price

  • 1Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.

Journal of Cardiac Failure
|June 1, 2011
PubMed

Insights

Mechanical circulatory support (MCS) offers a life-saving treatment for children with acute fulminant myocarditis. Survival rates are high, especially when viral infections are absent.

Area of Science:

  • Pediatric Cardiology
  • Critical Care Medicine
  • Cardiovascular Surgery

Background:

  • Acute fulminant myocarditis poses a significant threat to children's lives.
  • Mechanical circulatory support (MCS) shows promise in bridging pediatric patients to recovery or heart transplantation.

Purpose of the Study:

  • To evaluate the effectiveness of MCS in pediatric myocarditis cases.
  • To identify risk factors linked to adverse outcomes in children receiving MCS for myocarditis.

Main Methods:

  • Retrospective analysis of 16 children treated with MCS (extracorporeal membrane oxygenation, ventricular assist devices, or both) between 2001 and 2009.
  • Utilized polymerase chain reaction for viral pathogen detection and histologic analysis for myocardial inflammation assessment.

Main Results:

  • Overall survival rate was 75% (12/16), with 7 patients recovering ventricular function and 5 undergoing heart transplantation.
  • Significant improvement in left ventricular ejection fraction observed in patients bridged to recovery (20% to 62%, P = .0004).
  • Viral presence was associated with increased mortality or need for transplantation (P = .011); absence of viral infection and inflammation correlated with recovery (P values .011 and .044).

Conclusions:

  • MCS is a critical, life-saving intervention for children with acute fulminant and persistent myocarditis.
  • The absence of viral infection is a key factor associated with favorable outcomes in pediatric myocarditis patients treated with MCS.
Abstract

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