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Management of Myocarditis in Children: The Current Situation

  • Conference paper
Hot Topics in Infection and Immunity in Children IV

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 609))

Acute myocarditis is an important cause of morbidity and mortality in children. It is defined as inflammation of the myocardium in association with non-ischaemic myocellular necrosis (Aretz 1987). Despite its clear-cut definition, the classification, diagnosis and treatment of myocarditis remain the subject of ongoing debate. The use of endomyocardial biopsy, which has become routine, has helped to better define the natural history of human myocarditis and to clarify clinicopathological correlations.

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References

  • Aretz HT. (1987). Myocarditis: the Dallas criteria. Hum Pathol, 18:619–624.

    Article  PubMed  CAS  Google Scholar 

  • Badorff C and Knowlton KU. (2004). Dystrophin disruption in enterovirus-induced myocarditis and dilated cardiomyopathy: from bench to bedside. Med Microbiol Immunol (Berl), 193:121–126.

    Article  CAS  Google Scholar 

  • Bergelson JM, Cunningham JA, Droguett G, Kurt-Jones EA, Krithivas A, Hong JS, Horwitz MS, Crowell RL, and Finberg RW. (1997). Isolation of a common receptor for Coxsackie B viruses and adenoviruses 2 and 5. Science, 275:1320–1323.

    Article  PubMed  CAS  Google Scholar 

  • Chen JW, Zhou B, Yu QC, Shin SJ, Jiao K, Schneider MD, Baldwin HS, and Bergelson JM. (2006). Cardiomyocyte-specific deletion of the coxsackievirus and adenovirus receptor results in hyperplasia of the embryonic left ventricle and abnormalities of sinuatrial valves. Circ Res, 98:923–930.

    Article  PubMed  CAS  Google Scholar 

  • Cook LN. (2004). Update on extracorporeal membrane oxygenation. Paediatr Respir Rev, 5(Suppl A):S329–S337.

    Article  PubMed  Google Scholar 

  • Doolan A, Langlois N, and Semsarian C. (2004). Causes of sudden cardiac death in young Australians. Med J Aust, 180:110–112.

    PubMed  Google Scholar 

  • Duggal B, Pratap U, Slavik Z, Kaplanova J, and Macrae D. (2005). Milrinone and low cardiac output following cardiac surgery in infants: is there a direct myocardial effect? Pediatr Cardiol, 26:642–645.

    Article  PubMed  CAS  Google Scholar 

  • Duncan BW, Bohn DJ, Atz AM, French JW, Laussen PC, and Wessel DL. (2001). Mechanical circulatory support for the treatment of children with acute fulminant myocarditis. J Thorac Cardiovasc Surg, 122:440–448.

    Article  PubMed  CAS  Google Scholar 

  • English RF, Janosky JE, Ettedgui JA, and Webber SA. (2004). Outcomes for children with acute myocarditis. Cardiol Young, 14:488–493.

    Article  PubMed  Google Scholar 

  • Fabre A and Sheppard MN. (2006). Sudden adult death syndrome and other non-ischaemic causes of sudden cardiac death. Heart, 92:316–320.

    Article  PubMed  CAS  Google Scholar 

  • Fenster BE, Chan FP, Valentine HA, Yang E, McConnell MV, Berry GJ, and Yang PC. (2006). Images in cardiovascular medicine. Cardiac magnetic resonance imaging for myocarditis: effective use in medical decision making. Circulation, 113:e842–e843.

    Article  PubMed  Google Scholar 

  • Gullestad L, Aass H, Fjeld JG, Wikeby L, Andreassen AK, Ihlen H, Simonsen S, Kjekshus J, Nitter-Hauge S, Ueland T, Lien E, Froland SS, and Aukrust P. (2001). Immunomodulating therapy with intravenous immunoglobulin in patients with chronic heart failure. Circulation, 103:220–225.

    PubMed  CAS  Google Scholar 

  • Hetzer R, Alexi-Meskishvili V, Weng Y, Hubler M, Potapov E, Drews T, Hennig E, Kaufmann F, and Stiller B. (2006). Mechanical cardiac support in the young with the Berlin Heart EXCOR pulsatile ventricular assist device: 15 years’ experience. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006:99–108.

    Google Scholar 

  • Hoffman TM, Wernovsky G, Atz AM, Kulik TJ, Nelson DP, Chang AC, Bailey JM, Akbary A, Kocsis JF, Kaczmarek R, Spray TL, and Wessel DL. (2003). Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation, 107:996–1002.

    Article  PubMed  CAS  Google Scholar 

  • Karjalainen J and Heikkila J. (1999). Incidence of three presentations of acute myocarditis in young men in military service. A 20-year experience. Eur Heart J, 20:1120–1125.

    Article  PubMed  CAS  Google Scholar 

  • Kuhl U, Pauschinger M, Noutsias M, Seeberg B, Bock T, Lassner D, Poller W, Kandolf R, and Schultheiss HP. (2005). High prevalence of viral genomes and multiple viral infections in the myocardium of adults with “idiopathic” left ventricular dysfunction. Circulation, 111:887–893.

    Article  PubMed  Google Scholar 

  • Laer S, Mir TS, Behn F, Eiselt M, Scholz H, Venzke A, Meibohm B, and Weil J. (2002). Carvedilol therapy in pediatric patients with congestive heart failure: a study investigating clinical and pharmacokinetic parameters. Am Heart J, 143:916–922.

    Article  PubMed  CAS  Google Scholar 

  • Lieback E, Hardouin I, Meyer R, Bellach J, and Hetzer R. (1996). Clinical value of echocardiographic tissue characterization in the diagnosis of myocarditis. Eur Heart J, 17:135–142.

    PubMed  CAS  Google Scholar 

  • Lieberman EB, Hutchins GM, Herskowitz A, Rose NR, and Baughman KL. (1991). Clinicopathologic description of myocarditis. J Am Coll Cardiol, 18:1617–1626.

    Article  PubMed  CAS  Google Scholar 

  • Lin CH, Chang JS, and Li PC. (2005). The rescue of acute fulminant myocarditis by extracorporeal membrane oxygenation in pediatric patients. Acta Paediatr Taiwan, 46:201–205.

    PubMed  Google Scholar 

  • Liu PP and Mason JW. (2001). Advances in the understanding of myocarditis. Circulation, 104:1076–1082.

    Article  PubMed  CAS  Google Scholar 

  • Liu P and Sole MJ. (1999). What is the relevance of apoptosis to the myocardium? Can J Cardiol, 15(Suppl B):8B–10B.

    PubMed  Google Scholar 

  • Magnani JW and Dec GW. (2006). Myocarditis: current trends in diagnosis and treatment. Circulation, 113:876–890.

    Article  PubMed  Google Scholar 

  • Magnani JW, Danik HJ, Dec GW Jr., and DiSalvo TG. (2006). Survival in biopsy-proven myocarditis: a long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors. Am Heart J, 151:463–470.

    Article  PubMed  Google Scholar 

  • Maisch B, Ristic AD, Hufnagel G, Funck R, Alter P, Tontsch D, and Pankuweit S. (2002). Dilated cardiomyopathies as a cause of congestive heart failure. Herz, 27:113–134.

    Article  PubMed  Google Scholar 

  • Maisch B, Hufnagel G, Kolsch S, Funck R, Richter A, Rupp H, Herzum M, and Pankuweit S. (2004). Treatment of inflammatory dilated cardiomyopathy and (peri) myocarditis with immunosuppression and i.v. immunoglobulins. Herz, 29:624–636.

    Article  PubMed  Google Scholar 

  • Mason JW, O’Connell JB, Herskowitz A, Rose NR, McManus BM, Billingham ME, and Moon TE. (1995). A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators. N Engl J Med, 333:269–275.

    Article  PubMed  CAS  Google Scholar 

  • Matsumori A, Yamada T, Suzuki H, Matoba Y, and Sasayama S. (1994). Increased circulating cytokines in patients with myocarditis and cardiomyopathy. Br Heart J, 72:561–566.

    Article  PubMed  CAS  Google Scholar 

  • Matsumori A, Igata H, Ono K, Iwasaki A, Miyamoto T, Nishio R, and Sasayama S. (1999). High doses of digitalis increase the myocardial production of proinflammatory cytokines and worsen myocardial injury in viral myoc arditis: a possible mechanism of digitalis toxicity. Jpn Circ J, 63:934–940.

    Article  PubMed  CAS  Google Scholar 

  • McCarthy RE III, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Hare JM, and Baughman KL. (2000). Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med, 342:690–695.

    Article  PubMed  Google Scholar 

  • McNamara DM, Holubkov R, Starling RC, Dec GW, Loh E, Torre-Amione G, Gass A, Janosko K, Tokarczyk T, Kessler P, Mann DL, and Feldman AM. (2001). Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy. Circulation, 103:2254–2259.

    PubMed  CAS  Google Scholar 

  • Nakamura H, Yamamoto T, Yamamura T, Nakao F, Umemoto S, Shintaku T, Yamaguchi K, Liu P, and Matsuzaki M. (1999). Repetitive coxsackievirus infection induces cardiac dilatation in post-myocarditic mice. Jpn Circ J, 63:794–802.

    Article  PubMed  CAS  Google Scholar 

  • Nishio R, Shioi T, Sasayama S, and Matsumori A. (2003). Carvedilol increases the production of interleukin-12 and interferon-gamma and improves the survival of mice infected with the encephalomyocarditis virus. J Am Coll Cardiol, 41:340–345.

    Article  PubMed  CAS  Google Scholar 

  • Ono K, Matsumori A, Shioi T, Furukawa Y, and Sasayama S. (1998). Cytokine gene expression after myocardial infarction in rat hearts: possible implication in left ventricular remodeling. Circulation, 98:149–156.

    PubMed  CAS  Google Scholar 

  • Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, and Shusterman NH. (1996). The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med, 334:1349–1355.

    Article  PubMed  CAS  Google Scholar 

  • Parrillo JE, Cunnion RE, Epstein SE, Parker MM, Suffredini AF, Brenner M, Schaer GL, Palmeri ST, Cannon RO III, and Alling D et al. (1989). A prospective, randomized, controlled trial of prednisone for dilated cardiomyopathy. N Engl J Med, 321:1061–1068.

    PubMed  CAS  Google Scholar 

  • Penninger JM, Pummerer C, Liu P, Neu N, and Bachmaier K. (1997). Cellular and molecular mechanisms of murine autoimmune myocarditis. Apmis, 105:1–13.

    Article  PubMed  CAS  Google Scholar 

  • Shioi T, Matsumori A, Nishio R, Ono K, Kakio T, and Sasayama S. (1997). Protective role of interleukin-12 in viral myocarditis. J Mol Cell Cardiol, 29:2327–2334.

    Article  PubMed  CAS  Google Scholar 

  • Stiller B, Dähnert I, Weng Y, Hennig E, Hetzer R, and Lange P. (1999). Children may survive severe myocarditis with prolonged use of biventricular assist devices. Heart, 82:237–240.

    PubMed  CAS  Google Scholar 

  • Stiller B, Hetzer R, Weng Y, Hummel M, Hennig E, Nagdyman N, Ewert P, Lehmkuhl H, and Lange P. (2003). Heart transplantation in children after mechanical circulatory support with pulsatile pneumatic assist device. J Heart Lung Transplant, 22:1201–1208.

    Article  PubMed  Google Scholar 

  • Stiller B, Lemmer J, Merkle F, Alexi-Meskishvili V, Weng Y, Hübler M, Koster A, Drews T, Lange P, and Hetzer R. (2004). Consumption of blood products during mechanical circulatory support in children: comparison between ECMO and a pulsatile ventricular assist device. Intensive Care Medicine, 30:1814–1820.

    Article  PubMed  Google Scholar 

  • Stiller B, Weng Y, Hubler M, Lemmer J, Nagdyman N, Redlin M, Lange P, and Hetzer R. (2005). Pneumatic pulsatile ventricular assist devices in children under 1 year of age. Eur J Cardiothorac Surg, 28:234–239.

    Article  PubMed  Google Scholar 

  • Towbin J. (2001). Myocarditis. In: Allen HD GH, Clarc EB, and Driscoll D, (eds.), Moss and Adams’ Heart Disease in Infants, Children, and Adolescents. Lippincott Williams and Wilkins, Philadelphia, PA.

    Google Scholar 

  • Wakafuji S and Okada R. (1986). Twenty year autopsy statistics of myocarditis incidence in Japan. Jpn Circ J, 50:1288–1293.

    PubMed  CAS  Google Scholar 

  • Yamada T, Matsumori A, and Sasayama S. (1994). Therapeutic effect of anti-tumor necrosis factor-alpha antibody on the murine model of viral myocarditis induced by encephalomyocarditis virus. Circulation, 89:846–851.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Congenital Heart Defects, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Brigitte Stiller

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  1. Brigitte Stiller
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Editors and Affiliations

  1. Institute of Child Life and Health UBHT Education Centre, University of Bristol, Upper Maudlin Street, Bristol, BS2 8AE, UK

    Adam Finn

  2. Department of Paediatrics, University of Oxford, Level 4, John Radcliffe Hospital, Oxford, OX3 9DU, UK

    Andrew J. Pollard

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Stiller, B. (2008). Management of Myocarditis in Children: The Current Situation. In: Finn, A., Pollard, A.J. (eds) Hot Topics in Infection and Immunity in Children IV. Advances in Experimental Medicine and Biology, vol 609. Springer, New York, NY. https://doi.org/10.1007/978-0-387-73960-1_15

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