Holodiastolic Flow Reversal in the Descending Aorta: A Marker of Concomitant Acute Myocarditis and Aortitis in Children-A Case Series.

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.