Pediatric Cardiology and Cardiac Surgery
Vol.26 No.3 2010 (227-233)
Ki-Sung Kim,1,3) Kazuhide Ando,1) Hiroko Asakai,1) Taiyu Hayashi,1,3) Masahide Kaneko,1) Yasushi Misaki,1) Ichiro Saito,2) Akihiko Sekiguchi,4) and Hitoshi Kato1)
1)Division of Cardiology and 2)Department of Anesthesia and ICU, National Center for Child Health and Development, Tokyo, 3)Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, and 4)Department of Surgery, Sano City Hospital, Tochigi, Japan
Background: An increasing number of cases of fulminant myocarditis are being successfully treated using percutaneous cardiopulmonary support (PCPS), but there are few reports describing the prognosis of acute myocarditis including the fulminant type in children.
Methods: Twenty-six events of acute myocarditis in 25 (15 male and 11 female) cases treated at our institution from January 2002 to December 2008 were included in the study, including one patient who suffered the disease twice. Their medical records were retrospectively reviewed.
Results: Patients were aged 0 month to 12 years 11 months (median: 4 years 5 months) at the onset of the disease. The overall survival rate was 81% (21/26), and the survival rate in patients treated with PCPS was 63% (5/8). Heart transplantation, as a treatment for acute myocarditis, was performed in none of the patients. The reason for death in all 3 patients in PCPS group was brain damage, and cardiopulmonary resuscitation was performed before initiation of PCPS in all of them. All the survivors were doing well, and in all of them left ventricular ejection fraction was >0.47 and no neurological sequel was observed at the latest follow-up. The proportions of patients in whom cardiopulmonary resuscitation was performed or who had ventricular tachycardia or fibrillation were higher in non-survivors than those in survivors.
Conclusions: The prognosis of pediatric acute myocarditis in our institution under utilization of PCPS was satisfactory. Earlier diagnosis and immediate transfer to the tertiary center are crucial for the further improvement of prognosis.