Heusch A, Kühl U, Rammos S, Krogmann O N, Schultheiss H P, Bourgeois M
Department of Paediatric Cardiology, Heinrich-Heine-University, Düsseldorf, Germany.
Eur J Pediatr. 1996 Aug;155(8):633-6. doi: 10.1007/BF01957142.
We report two children with acquired third degree AV-block caused by acute myocarditis. The diagnosis was proven by endomyocardial biopsy. Severe lymphocytic myocardial infiltration was shown using immunohistological methods. One of the children was treated with prednisone During therapy conduction disturbance nearly disappeared and infiltration was markedly reduced in a subsequent biopsy. In the other patient the parents refused immunosuppressive treatment and a permanent pacemaker was necessary for persistent bradycardia.
Immunohistological staining of an endomyocardial biopsy can be used to establish the diagnosis of myocarditis in patients with atypical clinical manifestation, such as complete AV-block, and can support the decision for therapy. In one patient improvement was documented by the disappearance of inflammatory activity in a repeated biopsy.
我们报告了两名因急性心肌炎导致获得性三度房室传导阻滞的儿童。心内膜心肌活检证实了诊断。采用免疫组织学方法显示有严重的淋巴细胞性心肌浸润。其中一名儿童接受了泼尼松治疗。治疗期间传导障碍几乎消失，后续活检显示浸润明显减少。另一名患者的父母拒绝免疫抑制治疗，因持续性心动过缓需要植入永久性起搏器。
心内膜心肌活检的免疫组织学染色可用于确诊临床表现不典型（如完全性房室传导阻滞）的心肌炎患者，并有助于治疗决策。在一名患者中，重复活检显示炎症活动消失，证明病情有所改善。
