Malakan Rad Elaheh, Pourlaiakbar Hamidreza, Gorji Mojtaba, Hijazi Ziyad M
Research Center for the Prevention of Cardiovascular Diseases and the Promotion of Fetal, Pediatric, and Adolescent Cardiovascular Health, Affiliated with Tehran University of Medical Sciences (TUMS), No.62, Dr. Gharib's Street, End of Keshavarz Boulevard, Tehran, 1419733151, Iran.
Shahid Rajaei Cardiovascular Medical and Research Institute, Tehran, Iran.
Pediatr Cardiol. 2025 Mar 18. doi: 10.1007/s00246-025-03810-y.
This case series describes five pediatric patients with acute myocarditis presenting holodiastolic flow reversal in the descending aorta despite the absence of aortic run-off lesions. This Doppler finding highlights the role of aortitis or Concomitant Acute Myocarditis and Aortitis (CAMA). Cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) confirmed myocarditis in three cases. Key findings included poor response to exogenous catecholamines, elevated troponin I, hyponatremia, low vitamin D, and frequent biventricular involvement. Outcomes included one successful cardiac transplantation, one requiring levosimendan, and three fatalities. Low diastolic blood pressure and flow reversal in the descending aorta are critical clues for diagnosing CAMA. Clinical implications, pathophysiology, and management are discussed.
本病例系列描述了5例患有急性心肌炎的儿科患者，尽管没有主动脉分流病变，但降主动脉出现全舒张期血流逆转。这一多普勒发现凸显了主动脉炎或合并急性心肌炎和主动脉炎（CAMA）的作用。延迟钆增强（LGE）心脏磁共振成像（MRI）在3例中证实了心肌炎。主要发现包括对外源性儿茶酚胺反应不佳、肌钙蛋白I升高、低钠血症、低维生素D以及频繁的双心室受累。结果包括1例成功进行心脏移植，1例需要使用左西孟旦，3例死亡。舒张压降低和降主动脉血流逆转是诊断CAMA的关键线索。文中讨论了临床意义、病理生理学和治疗方法。
