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

Thushiha Logeswaran1, Hakan Akintürk2, Dietmar Schranz3

  • 1Department of Pediatric Cardiology, Intensive Care Medicine and Congenital Heart Disease, Pediatric Heart Center, Justus-Liebig-University, Giessen, Germany.

JACC. Advances
|July 17, 2026
PubMed

Insights

A novel treatment strategy combining left atrial decompression and pulmonary artery banding (PAB) shows promise for myocardial recovery in young children with myocarditis-associated dilated cardiomyopathy (DCM). This approach may improve outcomes for pediatric heart failure patients.

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.
Abstract

Keywords:
dilated cardiomyopathymechanical circulatory supportmyocarditispulmonary artery bandingrecoveryrestrictive ASD

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