Acute myocarditis in children. A study of 11 clinical cases.

The diagnosis of acute myocarditis in children is based on histological cri teria. Often viral in origin, it results in acute left ventricular dysfunct ion, the clinical manifestations of which are very variable. The potential severity of the disease is maximal in its initial phase, justifying rapid a nd intensive treatment. Long-term outcome is relatively good although there is a risk of chronic left ventricular dysfunction. This retrospective study is based on 11 cases of acute myocarditis admitted to the paediatric unit of Clermont-Ferrand University Hospital between Feb ruary 1989 and March 1999. The initial symptoms were non-specific. Echocard iography was the key diagnostic procedure. Half of the patients had severe cardiac failure requiring admission to the intensive care unit. Four cases presented with a severe complication : two embolic events, one syncopal atr ioventricular block and one cardiac arrest. The cardiac treatment was class ical (digitalis, diuretics, angiotensin converting enzyme inhibitors, antic oagulants). The aetiology was established in 3 cases (toxoplasmosis, haemol ytic and uraemic syndrome, Kawasaki) and a viral cause was suspected in 6 o ther cases (adenovirus in 3 cases, herpes virus, RSV and enterovirus in 1 c ase). There were no deaths in the acute phase. The long-term outcome was gl obally good : complete regression in 8 cases, 1 chronic left ventricular dy sfunction and 2 late deaths due to intractable cardiac failure. This short series illustrates the often misleading presentation of acute my ocarditis in childhood, the value of systematic investigation in the hope o f a specific treatment becoming available in the near future for the often viral aetiology.