[Immunosuppressive drugs for the treatment of active myocarditis in children. Hemodynamic evaluation].
OBJECTIVE
To analyse hemodynamic parameters (left ventricles ejection fraction, cardiac index, mean pulmonary wedge pressure and left ventricle diastolic diameter, in a group of children with active myocarditis (diagnosed by endomyocardial biopsy) pre and post treatment with conventional therapy and immunosuppressive drugs (isolated prednisone or prednisone associated with azathioprine or cyclosporine).


METHODS
Forty-four pediatric patients with active myocarditis were studied. Twenty males and 24 females from 10 months to 15 years old (median = 1.3 years). All patients were submitted to hemodynamic study and endomyocardial biopsy. The hemodynamic parameters mentioned above were analysed before and after the proposed therapy. The patients were distributed in group according to the admission in the protocol, group I (9 pts)--conventional therapy (CT); group II (12 pts)--CT plus prednisone; group III (16 pts)--CT plus prednisone plus azathioprine; group IV (13 pts)--CT plus prednisone plus cyclosporine.


RESULTS
Forty-four patients were submitted to four different groups of therapeutic protocol. The hemodynamic parameters were analysed in each of them. Left ventricle ejection fraction were no significantly different in the pre and post therapeutic scheme in group I and II, they were significantly higher (p less than 0.05) in group III and IV. The same happened with cardiac index. The mean pulmonary wedge pressure no presented statistical differences in group I and II before and after treatment but significantly lower lends were observed in group III and IV. The same behavior were noted in the left ventricle end diastolic diameter.


CONCLUSIONS
The association of azathioprine or cyclosporine to prednisone presented better results in the left ventricle function, when compared with conventional drugs or isolated use of prednisone, based in the analysis of same hemodynamic parameters.
Camargo
P R
PR
Instituto do Coração do Hospital das Clínicas, FMUSP.
Mazzieri
R
R
Snitcowsky
R
R
Ratti
M
M
Costa
R
R
Higuchi
M L
ML
Albuquerque
A M
AM
Meneghetti
C
C
Ebaid
M
M
Pileggi
F
F
D000293:Adolescent; D001379:Azathioprine / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003524:Cyclosporins / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005710:Gallium Radioisotopes; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008297:Male; D009205:Myocarditis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D011241:Prednisone / Q000627:therapeutic use*; D011877:Radionuclide Imaging
D003524:Cyclosporins; D005710:Gallium Radioisotopes; D001379:Azathioprine; D011241:Prednisone
Drogas imunossupressoras no tratamento da miocardite ativa na criança. Avaliação hemodinâmica.