Skip to main content Accessibility help
×
×
Home

Outcomes for children with acute myocarditis

  • Robert F. English (a1), Janine E. Janosky (a2), Jose A. Ettedgui (a1) and Steven A. Webber (a3)

Abstract

The optimum treatment for myocarditis in children is unknown. We present outcomes for this disease as seen in a large series of children. Thus, we identified all children seen with myocarditis at Children’s Hospital of Pittsburgh since 1985, including only those with biopsy-proven myocarditis, or cardiac dysfunction and proof of concomitant cardiotropic viral infection. Outcomes were defined as complete recovery, incomplete recovery, and death or transplantation.

We identified 41 patients, 37 proven by histology, and 4 patients who were too unstable for biopsy but had proof of viral infection. Of the group, 27 (66%) made a complete recovery, 4 (10%) had incomplete recovery, and 10 (24%) either died (5) or underwent transplantation (5). The median time to death or transplantation was 8.4 months, with a range from 1 day to 49 months. Steroids had been administered to 16 patients, of whom 10 made a complete recovery, 2 an incomplete recovery, 2 died, and 2 were transplanted. Intravenous immune globulin was given in isolation to one patient, who made a complete recovery, and to 18 in combination with steroids, of whom 12 made a complete recovery, 2 an incomplete recovery, 2 died, and 2 were transplanted. The remaining 6 patients received neither steroids nor intravenous immune globulin, and of these, 4 made a complete recovery, 1 was transplanted, and 1 died. Freedom from death or transplantation was 81% at 1 year, and 74% at 5 years, with no difference between the modes of treatments. The median time to recovery of function was also comparable between the groups. Thus, in our patients, treatment with intravenous immune globulin appeared to confer no advantage to steroid therapy alone. These data emphasise the need for randomised trials to assess the efficacy of current treatments, as well as that of new therapies.

Copyright

Corresponding author

Correspondence to: Robert F. English MD, University of Florida, Pediatric Cardiovascular Center, 1443 San Marco Boulevard, Jacksonville, FL 32207, USA. Tel: +1 904 493 1610; Fax: +1 904 493 2363; E-mail: robert.english@jax.ufl.edu

References

Hide All

References

Drucker NA, Colan SD, Lewis AB, et al. Gamma-globulin treatment of acute myocarditis in the pediatric population. Circulation 1994; 89: 252257.
Liu PP, Mason JW. Advances in the understanding of myocarditis. Circulation 2001; 104: 10761082.
Kleinert S, Weintraub RG, Wilkinson JL, Chow CW. Myocarditis in children with dilated cardiomyopathy: incidence and outcome after dual therapy immunosuppression. J Heart Lung Transplant 1997; 16: 12481254.
Levi D, Alejos J. Diagnosis and treatment of pediatric viral myocarditis. Curr Opin Cardiol 2001; 16: 7783.
Ahdoot J, Galindo A, Alejos JC, et al. Use of OKT3 for acute myocarditis in infants and children. J Heart Lung Transplant 2000; 19: 11181121.
Aretz HT, Billingham ME, Edwards WD, et al. Myocarditis: a histopathologic definition and classification. Am J Cardiovasc Pathol 1987; 1: 314.
Aber CP, Jones EW. Corticotrophin and corticosteroids in the management of acute and chronic heart block. Br Heart J 1965; 27: 916925.
Yigitbasi O, Malbantgil I. [Use of steroids in heart blocks.] Rev Med Moyen Orient 1965; 22: 420424.
Das SK, Cassidy JT, Petty RE. The significance of heart-reactive antibodies in heart disease. Chest 1974; 66: 179181.
Sainani GS, Krompotic E, Slodki SJ. Adult heart disease due to Coxsackie B infection. Medicine (Baltimore) 1968; 47: 133147.
Obeyesekere I, Hermon Y. Myocarditis and cardiomyopathy after arbovirus infections (dengue and chikungunya fever). Br Heart J 1972; 34: 821827.
Hirschman SZ, Hammer GS. Coxsackie virus myopericarditis: a microbiological and clinical review. Am J Cardiol 1974; 34: 224232.
Lerner AM. Coxsackievirus myocardiopathy. J Infect Dis 1969; 120: 496499.
Voight GC. Steroid therapy in viral myocarditis. Am Heart J 1968; 75: 575576.
Mason JW, Billingham ME, Ricci DR. Treatment of acute inflammatory myocarditis assisted by endomyocardial biopsy. Am J Cardiol 1980; 45: 10371044.
Chan KY, Iwahara M, Benson LN, Wilson GJ, Freedom RM. Immunosuppressive therapy in the management of acute myocarditis in children: a clinical trial. J Am Coll Cardiol 1991; 17: 458460.
Latham RD, Mulrow JP, Virmani R, Robinowitz M, Moody JM. Recently diagnosed idiopathic cardiomyopathy: incidence of myocarditis and efficacy of prednisone therapy. Am Heart J 1989; 117: 876882.
Tomioka N, Kishimoto C, Matsumori A. Effects of prednisone on acute viral myocarditis in mice. J Am Coll Cardiol 1986; 7: 868872.
Hosenpud JD, McAnulty JH, Niles NR. Lack of objective improvement in ventricular systolic function in patients with myocarditis treated with azathioprine and prednisone. J Am Coll Cardiol 1985; 6: 797801.
McNamara DM, Rosenblum WD, Janosko KM, et al. Intravenous immune globulin in the therapy of myocarditis and acute cardiomyopathy. Circulation 1997; 95: 24762478.
McNamara DM, Holubkov R, Starling RC, et al. Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy. Circulation 2001; 103: 22542259.
Webber SA, Boyle GJ, Jaffe R, Pickering RM, Beerman LB, Fricker FJ. Role of right ventricular endomyocardial biopsy in infants and children with suspected or possible myocarditis. Br Heart J 1994; 72: 360363.
Frustaci A, Chimenti C, Calabrese F, Pieroni M, Thiene G, Maseri A. Immunosuppressive therapy for active lymphocytic myocarditis: virological and immunologic profile of responders versus nonresponders. Circulation 2003; 107: 857863.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed