title: Effectiveness of mechanical circulatory support in children with acute fulminant and persistent myocarditis.
abstract: BACKGROUND
  Acute fulminant myocarditis is a life-threatening disease in children. A limited number of reports suggest that mechanical circulatory support (MCS) may be used to successfully bridge children with acute fulminant myocarditis to recovery or transplantation. We evaluated the effectiveness of MCS in children with myocarditis and identified risk factors associated with adverse outcomes.
  
  
  RESULTS
  Between 2001 and 2009, 16 children were treated for myocarditis at our institution; each child received MCS provided by extracorporeal membrane oxygenation, ventricular assist device(s), or both. Of these patients, 75% (12/16) survived: 7 recovered ventricular function, and 5 underwent successful orthotopic heart transplantation. In patients who were bridged to recovery, mean left ventricular ejection fraction significantly improved from initiation to termination of MCS (20 ± 9.3% to 62 ± 5%; P = .0004). Viral pathogens were detected in 11 patients by polymerase chain reaction, and viral presence was associated with death or need for transplantation (P = .011). Upon histologic analysis, absence of viral infection and lack of myocardial inflammation were associated with recovery (P values .011 and .044, respectively).
  
  
  CONCLUSIONS
  In children with acute fulminant and persistent myocarditis, MCS is a life-saving treatment strategy, particularly in the absence of viral infection.
authors.affiliation: Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
authors.forename: Ivan
authors.initials: I
authors.lastname: Wilmot
authors.forename: David L S
authors.initials: DL
authors.lastname: Morales
authors.forename: Jack F
authors.initials: JF
authors.lastname: Price
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Rossano
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Decker
authors.forename: Mary Claire
authors.initials: MC
authors.lastname: McGarry
authors.forename: Susan W
authors.initials: SW
authors.lastname: Denfield
authors.forename: William J
authors.initials: WJ
authors.lastname: Dreyer
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Towbin
authors.forename: John L
authors.initials: JL
authors.lastname: Jefferies
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009205:Myocarditis / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014777:Virus Diseases / Q000150:complications*