Treatment and prognosis of fulminant myocarditis in children

Abstract

Objective To summarize clinical features and treatment of fulminant myocarditis (FMC) in children. Methods A retrospective study was done at Department of Cardiology, Children's Hospital of Chongqing Medical University from Jun.1998 to Oct.2012.All of these 70 patients were diagnosed as FMC.And the etiology, cardiac crea-tase and cardiac troponin test, electrocardiogram (ECG), echocardiography (UCG), treatment and prognosis were collected for clinical analysis. Results Etiology: coxsackie virus B (CBV) was the most common pathogen (35.71%, 15/42 cases). Cardiac creatase and cardiac troponin test: there were 94.44%(51/54 cases) of the children with diffe-rent degree of abnormal cardiac creatase, 74.07%(40/54 cases) with increased creatine kinase-MB(CK-MB), and only 31.11%(14/45 cases) with abnormal cardiac troponin.ECG: there were 93.85%(61/65 cases) of the children with abnormal ECG, and the changes for ST-T and arrhythmia were most common.UCG: about 93.10%(27/29 cases) patients showed abnormal UCG such as cardiac enlargement, low velocity motion of the ventricular wall, decreased left ventricular ejection fraction and left ventricular fraction shortening.After comprehensive and active treatment, 28 cases (40.00%, 28/70 cases) were cured, 33 cases (47.14%, 33/70 cases) died, and 9 cases were lost to follow-up.In general, the use of glucocorticoid/intravenous gamma globulin (IVIG) could improve the cure rate of FMC (P<0.05). Conclusions FMC of children was fast progressing with high mortality which was featured with increased CK-MB, always companied with abnormal ECG and UCG.The leading pathogen is CBV.In addition, the accurate diagnosis as early as possible and active therapy, including the use of glucocorticoid/ IVIG, might help to improve the cure rate. Key words: Fulminant myocarditis; Clinical analysis; Child