Clinical outcomes of acute myocarditis in childhood

Objective-To describe clinical outcomes of a paediatric population with his tologically confirmed lymphocytic myocarditis. Design-A retrospective review between November 1984 and February 1998. Setting-A major paediatric tertiary care hospital. Patients-36 patients with histologically confirmed lymphocytic myocarditis. Main outcome measures-Survival, cardiac transplantation, recovery of ventri cular function, and persistence of dysrhythmias. Results-Freedom from death or cardiac transplantation was 86% at one month and 79% after two years. Five deaths occurred within 72 hours of admission, and one late death at 1.9 years. Extracorporeal membrane oxygenation suppo rt was used in four patients, and three patients underwent heart replacemen t. 34 patients were treated with intravenous corticosteroids. In the surviv or/non-cardiac transplantation group (n = 29), the median follow up was 19 months (range 1.2-131.6 months), and the median period for recovery of a le ft ventricular ejection fraction to > 55% was 2.8 months (range 0-28 months ). The mean (SD) final left ventricular ejection and shortening fractions w ere 66 (9)% and 34 (8)%, respectively. Two patients had residual ventricula r dysfunction. No patient required antiarrhythmic treatment. All survivors reported no cardiac symptoms or restrictions in physical activity. Conclusions-Our experience documents good outcomes in paediatric patients p resenting with acute heart failure secondary to acute lymphocytic myocardit is treated with immunosuppression. Excellent survival and recovery of ventr icular function, with the absence of significant arrhythmias, continued car diac medications, or restrictions in physical activity were the normal outc omes.