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Myocardial calcification: a predictor of poor outcome for myocarditis treated with extracorporeal life support
A Stallion1, J F Rafferty, B W Warner
1Department of Surgery, Cincinnati Children's Hospital, University of Cincinnati Medical Center, OH 45267-0558.
Insights
Severe myocarditis can cause myocardial calcification, indicating poor prognosis. Extracorporeal life support (ECLS) may not be beneficial when significant calcification and lack of cardiac function recovery occur.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Myocarditis is an inflammatory heart condition with diverse etiologies.
- It can be reversible, with extracorporeal life support (ECLS) offering a treatment option.
- Severe myocarditis can lead to significant myocardial damage and potential calcification.
Purpose of the Study:
- To evaluate the prognostic significance of myocardial calcification in pediatric patients with severe myocarditis treated with ECLS.
- To determine if myocardial calcification predicts outcomes in severe myocarditis.
Main Methods:
- Retrospective analysis of five pediatric patients (neonates to 5 years) with severe myocarditis.
- Treatment with venoarterial ECLS for medically refractory cases.
- Assessment of myocardial calcification using chest roentgenograms and echocardiograms.
Main Results:
- Three of five patients (60%) survived ECLS treatment.
- Nonsurvivors exhibited significant myocardial calcification and minimal recovery of cardiac function.
- Survivors showed no evidence of myocardial calcification.
Conclusions:
- Progressive myocardial calcification in severe myocarditis signifies extensive myocardial damage.
- The presence of calcification and lack of cardiac function recovery indicates a poor prognosis.
- Continued ECLS may not be warranted in cases with significant calcification and no functional recovery.
Abstract:
Myocarditis is an inflammatory disease of the myocardium with a variety of causes. It is potentially reversible, and has been treated successfully with extracorporeal life support (ECLS). With increasing severity, myocarditis results in significant damage to myocardial cells. Dystrophic calcification of the myocardium may occur, serving as a marker of severe damage. At the authors' institution, from July 1990 to January 1992, five patients (four neonates, one 5 year old) with severe myocarditis refractory to medical management were treated with venoarterial ECLS. Three survived (60%) and two died. All patients were female, and their age range was 2 weeks to 5 years. Nonsurvivors had significant myocardial calcification, which was detected by a chest roentgenogram as well as a two-dimensional echocardiogram; the three survivors had no evidence of calcification. The nonsurvivors had minimal recovery of myocardial function and subsequently had their ECLS discontinued at 83 and 169 hours, respectively. The authors conclude that the development of progressive myocardial calcification in conjunction with a lack of recovery of cardiac function is a sign of severe myocardial damage and poor prognosis. Continuation of ECLS in this setting may not be warranted.