[Immunosuppressive therapy in congestive cardiomyopathy in childhood].
Two patients aged ten and fourteen years presented with clinical signs of acute viral myocarditis and cardiac failure. Within three months both showed clinical deterioration with development of severe mitral and tricuspid incompetence. From their third month of illness myocardial antibodies were constantly found by indirect immunofluorescence technique. Both were treated with prednisone 2 mg/kg/d and azothioprine 2-2,5 mg/kg/d from their ninth and third month of illness for fifteen and twelve months respectively. Both showed considerable improvement within weeks with resolution of their valve incompetence, diminution of heart size and normalization of their ECGs. Results from myocardial biopsies suggest that a number of patients with chronic congestive cardiomyopathy may have long lasting viral inflammation of the myocardium or myocardial fiber destruction by autoimmunmechanisms after viral infection. Our cases probably had acute myocarditis which led to chronic congestive cardiomyopathy. Immunosuppressive therapy seems to be justified in cases where chronic inflammation or destruction of the myocardium is suspected because of the results of cardiac biopsies, myocardial scintigraphy or demonstration of myocardial antibodies.
D000293:Adolescent; D001323:Autoantibodies / Q000032:analysis; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000276:immunology; D001379:Azathioprine / Q000627:therapeutic use*; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy* / Q000276:immunology; D002648:Child; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009206:Myocardium / Q000276:immunology; D011241:Prednisone / Q000627:therapeutic use*
D001323:Autoantibodies; D001379:Azathioprine; D011241:Prednisone
Immunsuppressive Therapie bei kongestiver Kardiomyopathie im Kindesalter.