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[Immunosuppressive treatment of chronic myocarditis]
M Wimmer1, E Proll, U Salzer-Muhar
1Universitäts-Kinderklinik, Wien.
Insights
Immunosuppressive therapy improved heart function in children with severe heart failure post-viral infection when conventional treatments failed. This approach may benefit critical cases of congestive cardiomyopathy.
Area of Science:
- Pediatric Cardiology
- Immunology
Context:
- Viral infections can trigger severe heart failure in children.
- Conventional therapies (bed rest, anticongestive drugs) are often insufficient for severe pediatric heart failure.
Purpose:
- To evaluate the efficacy of immunosuppressive therapy in children with severe heart failure unresponsive to conventional treatment.
- To assess outcomes of immunosuppressive therapy for suspected chronic myocarditis or endocardial fibrosis.
Summary:
- Six children with severe heart failure post-viral infection received immunosuppressive therapy (prednisolone, azathioprine).
- Three children showed significant improvement in cardiac function, size, and ECG.
- One child experienced relapse upon therapy interruption, reversed by readministration; two died from progressive heart failure.
- Heart transplantation was successful in a patient with terminal dilated cardiomyopathy.
Impact:
- Immunosuppressive therapy offers a potential treatment option for severe, refractory pediatric congestive cardiomyopathy.
- This regimen may be justified in "hopeless cases" unresponsive to standard care.
- Further research is needed to identify specific patient selection criteria for immunosuppressive therapy.
Abstract:
6 children aged 9 months to 13 8/12 years developed reduced physical capacity, failure to thrive, dyspnoea on effort and heart failure after viral infection. Bed rest and anticongestive therapy did not reduce the severe heart failure. Immunosuppressive therapy with prednisolone 2 mg/kg/d and azathioprine 2 mg/kg/d was added on the assumption of chronic myocarditis (n = 4) or endocardial fibrosis (n = 2). 3 of the 6 children showed a considerable improvement in heart size, ECG and systolic heart function. Interruption of immunosuppressive therapy due to side effects in one child led to cardiac deterioration, which was reversed by renewed prednisolone therapy. Two patients died of progressive congestive heart failure. Heart transplantation was successfully performed in the now 14 year-old girl who was suffering from terminal dilated cardiomyopathy. Since there is no specific test for selecting patients who are likely to benefit from immunosuppressive therapy we feel this regimen would be justified in hopeless cases of congestive cardiomyopathy who have not responded to conventional therapy with anti-congestive drugs.