Acute Myocarditis in Children: Clinical Aspects and Outcomes

Kwon, Bo Sang; Lee, Chang Hun; Choi, Eun Young; Lee, Jung Ha; Jin, Sun Mi; Bae, Eun Jung; Noh, Chung Il; Yun, Yong Su

Abstract

PURPOSE
Myocarditis is an insidious inflammatory disorder of the myocardium. We investigated clinical characteristics, laboratory data, prognosis, and outcomes in patients with acute myocarditis.
METHODS
We retrospectively analyzed the medical records of 52 myocarditis patients who were admitted to the SNUCH from 1985 to 2005. We compared progressed group (included mortality and dilated cardiomyopathy) with recovery group.
RESULTS
The median age was 4.12 years. The median follow-up duration was 2.84 years. Sixteen patients(30.8%) recovered myocardial function. Twelve patients(23.1%) died; ten of them died because of fulminant myocarditis. Sixteen patients(30.8%) progressed to severe dilated cardiomyopathy. Twenty-one patients were treated with intravenous immunoglobulin(IVIG), and six patients took oral prednisone. Oral prednisone and IVIG showed no significant treatment effects(P=0.284, P=0.695). Six patients underwent temporary pacemaker due to complete atrioventricular block. Three patients underwent extracorporeal membrane oxygenation(ECMO), and 1 patient survived. Recently, survival rate for children with myocarditis was increased due to early intensive care and non-pharmacologic therapy(ECMO, ventricular assist device).
CONCLUSIONS
Steroid and IVIG were ineffective treatments in acute myocarditis. Patients with myocarditis needed an early intensive care. We expect that early aggressive treatments could improve patients' outcomes.