Experience of diagnosis and treatment of 19 cases with acute severe viral myocarditis in children

Abstract

Objective To explore the clinical features and treatment of children with acute severe viral myocarditis. Methods The clinical data of presentation, diagnosis, therapy and prognosis of children who were admitted in our hospital from Jan 2005 to Jan 2012 with acute severe viral myocarditis (severe myocarditis group) were analyzed retrospectively. Twenty-three cases of normal healthy children in the same period were selected as control group. The levels of serum cardiac troponin (CTn)-Ⅰand N-terminal pro-brain natriuretic peptide (NT-proBNP) were detected by ELISA method, the changes of left ventricular ejection fraction and left ventricular fraction shortening were understood by color doppler echocardiography. Results The level of CTn-Ⅰin severe myocarditis group was significantly higher than that of control group, the difference was statistically significant [(18.67±12.31) ng/ml vs (0.02±0.01) ng/ml, P<0.05]. Compared with the acute phase, the level of CTn-Ⅰshowed a trend of gradual decline in 7 d [(0.55±0.24) ng/ml], basic close to normal in 14 d [(0.06±0.03) ng/ml] (P<0.05). The level of NT-proBNP increased significantly in severe myocarditis group compared with control group [(3 067.26±902.79) pg/ml vs (80.04±17.79) pg/ml, P<0.05]. Compared with acute phase, the levels of NT-proBNP were closed to normal in 7 d [(648.63±342.37) pg/ml] and 14 d [(213.58±129.51) pg/ml] (P<0.05). The left ventricular ejection fraction [(52.63±6.98)% vs (71.39±2.41)%] and left ventricular fraction shortening [(32.1±2.97)% vs (40.04±2.31)%] in severe myocarditis group were significantly lower than those in control group (P<0.05). Conclusion Acute severe viral myocarditis of children was characterized by rapid onset, severe illness and high mortality. Early use of adrenal cortical hormone and gamma globulin under the comprehensive treatment and application temporary pacemaker can help patients to recover from the disease. Key words: Severe viral myocarditis; Diagnosis; Treatment; Children