Reverse Remodeling in Pediatric Myocarditis With DCM Phenotype Impact of rASD and PAB

Area of Science:

• Pediatric Cardiology
• Cardiovascular Surgery
• Pediatric Critical Care

Background:

• Myocarditis can progress to dilated cardiomyopathy (DCM) in children, leading to end-stage heart failure.
• The immature myocardium has age-dependent regenerative capacity, suggesting potential for intervention.

Purpose of the Study:

• To evaluate a staged, pathophysiology-guided strategy for myocardial recovery in infants and young children with myocarditis-associated DCM.
• The strategy combines left atrial decompression and pulmonary artery banding (PAB).

Main Methods:

• Retrospective analysis of 31 children under 3 years with biopsy-proven myocarditis and DCM phenotype.
• Standardized multimodal assessment including echocardiography, cardiac MRI, hemodynamic assessment, and endomyocardial biopsy.
• Interventions included creation of restrictive atrial communication and surgical PAB in selected patients.

Main Results:

• Patients presented with severe heart dysfunction (ejection fraction 24% ± 6.2%, elevated filling pressures).
• 90% overall survival at a median 2-year follow-up; 19% required heart transplantation.
• Among patients selected for PAB, 76% achieved sustained functional recovery.

Conclusions:

• A staged strategy of left atrial decompression and PAB can promote myocardial recovery in select pediatric patients with myocarditis-associated DCM.
• This approach offers a potential therapeutic option for young children with severe heart dysfunction.