Children may survive severe myocarditis with prolonged use of biventricular assist devices

Abstract

The outcome of acute myocarditis with cardiogenic shock is poor. In some children in whom aggressive medical treatment fails, artificial replacement of heart function may offer lifesaving support until the myocardium has recovered. Four previously healthy children (three boys aged 4, 6, and 1 years; one girl aged 5) developed acute myocarditis with ventricular failure and multiorgan dysfunction caused by low cardiac output. Biventricular assist devices (BVAD) were implanted for prolonged support. In three children cardiac function improved and after up to 21 days mechanical support could be withdrawn. They had full recovery of heart function. In the fourth patient there was no myocardial recovery after a period of 20 days. He underwent orthotopic heart transplantation with an uneventful postoperative course. Prolonged circulatory support with BVAD is an effective method for bridging until cardiac recovery or transplantation in children.

Figure 1

BVAD: top view and side view of the housing in diastolic and systolic position.

Figure 2

Paediatric assist systems. Two pumps for newborns (10 ml stroke volume) with different cannulae. One pump for infants (30 ml ) with Dacron covered middle part of the cannulae.

Figure 3

Patient 2 with BVAD (photograph published with permission of the child's parents).

Figure 4

Course of patient 4 before, during, and after BVAD. Platelets and protein S-100, a specific glia brain cell protein as a biochemical marker are shown.