Nahum Elhanan, Dagan Ovdi, Lev Amiram, Shukrun Golan, Amir Gabriel, Frenkel George, Katz Jacob, Michel Berant, Birk Einat
Department of Pediatric Intensive Care, Sackler Faculty of Medicine, Tel Aviv, Schneider Children's Medical Center of Israel, Tel Aviv University, Petach Tikva, 49202, Israel.
Pediatr Cardiol. 2010 Oct;31(7):1059-63. doi: 10.1007/s00246-010-9765-y. Epub 2010 Aug 24.
Myocarditis among pediatric patients varies in severity from mild disease to a fulminant course with overwhelming refractory shock and a high risk of death. Because the disease is potentially reversible, it is reasonable to deploy extracorporeal membranous oxygenation (ECMO) to bridge patients until recovery or transplantation. This study aimed to review the course and outcome of children with acute fulminant myocarditis diagnosed by clinical and echocardiographic data only who were managed by ECMO because of refractory circulatory collapse. A chart review of a single center identified 12 children hospitalized over an 8-year period who met the study criteria. Data were collected on demographics, diagnosis, disease course, and outcome. The patients ranged in age from 20 days to 8 years (25.5 ± 29.6 months). Echocardiography showed a severe global biventricular decrease in myocardial function, with a shortening fraction of 12% or less. Ten children (83.3%) were weaned off extracorporeal support after 100-408 h (mean, 209.9 ± 82.4 h) and discharged home. Two patients died: one due to multiorgan failure and one due to sustained refractory heart failure. During a long-term follow-up period, all survivors showed normal function in daily activities and normal myocardial function. The study showed that ECMO can be safely and successfully used for children with acute fulminant myocarditis diagnosed solely on clinical and radiographic grounds who need mechanical support. These patients usually have a favorable outcome, regaining normal or near normal heart function without a need for heart transplantation.
小儿心肌炎的严重程度各异，从轻症到暴发性病程，伴有严重的难治性休克和高死亡风险。由于该疾病具有潜在可逆性，因此采用体外膜肺氧合（ECMO）来支持患者直至康复或进行移植是合理的。本研究旨在回顾仅通过临床和超声心动图数据诊断为急性暴发性心肌炎且因难治性循环衰竭接受ECMO治疗的儿童的病程及预后。对单一中心的病历回顾确定了8年间住院的12名符合研究标准的儿童。收集了人口统计学、诊断、疾病病程及预后的数据。患者年龄从20天至8岁（平均25.5±29.6个月）。超声心动图显示心肌功能严重的全心双心室减退，缩短分数为12%或更低。10名儿童（83.3%）在100 - 408小时（平均209.9±82.4小时）后脱离体外支持并出院回家。两名患者死亡：一名死于多器官功能衰竭，一名死于持续性难治性心力衰竭。在长期随访期间，所有幸存者日常活动功能正常，心肌功能正常。该研究表明，ECMO可安全、成功地用于仅根据临床和影像学诊断为急性暴发性心肌炎且需要机械支持的儿童。这些患者通常预后良好，可恢复正常或接近正常的心功能，无需进行心脏移植。
