Mechanical circulatory support for the treatment of children with acute fulminant myocarditis

Background: Viral myocarditis may follow a rapidly progressive and fatal co urse in children. Mechanical circulatory support may be a life-saving measu re by allowing an interval for return of native ventricular function in the majority of these patients or by providing a bridge to transplantation in the remainder. Methods: A retrospective chart review of 15 children with viral myocarditis supported with extracorporeal membrane oxygenation (12 patients) or ventri cular assist devices (3 patients) was performed. Results: All patients had histories and clinical findings consistent with a cute myocarditis. The median age was 4.6 years (range 1 day-13.6 years) wit h a median duration of mechanical circulatory support of 140 hours (range 4 8-400 hours). Myocardial biopsy tissue demonstrated inflammatory infiltrate s or necrosis, or both, in 8 (67%) of the 12 patients who had biopsies. Ove rall survival was 12 (80%) of 15 patients, with 10 (83%) survivors of extra corporeal membrane oxygenation and 2 (67%) survivors of ventricular assist device support. Nine (60%) of the 15 patients were weaned from support, wit h 7 (78%) survivors; the remaining 6 patients were successfully bridged to transplantation, with 5 (83%) survivors. All survivors not undergoing trans plantation are currently alive with normal ventricular function after a med ian follow-up of 1.1 years (range 0.9-5.3 years). Conclusion: Eighty-percent of the children who required mechanical circulat ory support for acute myocarditis survived in this series. Recovery of nati ve ventricular function to allow weaning from support can be anticipated in many of these patients with excellent prospects for eventual recovery of f ull myocardial function.