Effectiveness of mechanical circulatory support in children with acute fulminant and persistent myocarditis

Ivan Wilmot, David L.S. Morales, Jack F. Price, Joseph W. Rossano, Jeffrey J. Kim, Jamie A. Decker, Mary Claire McGarry, Susan W. Denfield, William J. Dreyer, Jeffrey Towbin, John Jefferies

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background: Acute fulminant myocarditis is a life-threatening disease in children. A limited number of reports suggest that mechanical circulatory support (MCS) may be used to successfully bridge children with acute fulminant myocarditis to recovery or transplantation. We evaluated the effectiveness of MCS in children with myocarditis and identified risk factors associated with adverse outcomes. Methods and Results: Between 2001 and 2009, 16 children were treated for myocarditis at our institution; each child received MCS provided by extracorporeal membrane oxygenation, ventricular assist device(s), or both. Of these patients, 75% (12/16) survived: 7 recovered ventricular function, and 5 underwent successful orthotopic heart transplantation. In patients who were bridged to recovery, mean left ventricular ejection fraction significantly improved from initiation to termination of MCS (20 ± 9.3% to 62 ± 5%; P = .0004). Viral pathogens were detected in 11 patients by polymerase chain reaction, and viral presence was associated with death or need for transplantation (P = .011). Upon histologic analysis, absence of viral infection and lack of myocardial inflammation were associated with recovery (P values .011 and .044, respectively). Conclusions: In children with acute fulminant and persistent myocarditis, MCS is a life-saving treatment strategy, particularly in the absence of viral infection.

Original languageEnglish (US)
Pages (from-to)487-494
Number of pages8
JournalJournal of Cardiac Failure
Volume17
Issue number6
DOIs
StatePublished - Jun 1 2011
Externally publishedYes

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Myocarditis
Virus Diseases
Transplantation
Extracorporeal Membrane Oxygenation
Heart-Assist Devices
Ventricular Function
Heart Transplantation
Stroke Volume
Inflammation
Polymerase Chain Reaction

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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Effectiveness of mechanical circulatory support in children with acute fulminant and persistent myocarditis. / Wilmot, Ivan; Morales, David L.S.; Price, Jack F.; Rossano, Joseph W.; Kim, Jeffrey J.; Decker, Jamie A.; McGarry, Mary Claire; Denfield, Susan W.; Dreyer, William J.; Towbin, Jeffrey; Jefferies, John.

In: Journal of Cardiac Failure, Vol. 17, No. 6, 01.06.2011, p. 487-494.

Research output: Contribution to journalArticle

Wilmot, I, Morales, DLS, Price, JF, Rossano, JW, Kim, JJ, Decker, JA, McGarry, MC, Denfield, SW, Dreyer, WJ, Towbin, J & Jefferies, J 2011, 'Effectiveness of mechanical circulatory support in children with acute fulminant and persistent myocarditis', Journal of Cardiac Failure, vol. 17, no. 6, pp. 487-494. https://doi.org/10.1016/j.cardfail.2011.02.008
Wilmot, Ivan ; Morales, David L.S. ; Price, Jack F. ; Rossano, Joseph W. ; Kim, Jeffrey J. ; Decker, Jamie A. ; McGarry, Mary Claire ; Denfield, Susan W. ; Dreyer, William J. ; Towbin, Jeffrey ; Jefferies, John. / Effectiveness of mechanical circulatory support in children with acute fulminant and persistent myocarditis. In: Journal of Cardiac Failure. 2011 ; Vol. 17, No. 6. pp. 487-494.
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