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ORIGINAL ARTICLE
Korean J Pediatr 2014 November;57(11) :489-495.
Published online 2014 August 22.       
Clinical features and short-term outcomes of pediatric acute fulminant myocarditis in a single center
Eun Young Lee1, Hae Lyoung Lee1, Hyung Tae Kim2, Hyoung Doo Lee2, Ji Ae Park1
1Department of Pediatrics, Good Gang-An Hospital, Busan, Korea
2Heart Center, Pusan National University Childrens Hospital, Yangsan, Korea
Corresponding Author: Ji Ae Park ,Tel: +82-51-610-9876, Fax: +82-51-6625-0206, Email: amore78@hanmail.net
Copyright © 2014 by The Korean Pediatric Society
ABSTRACT
Purpose: The aims of this study were to document our single-center experience with pediatric acute fulminant myocarditis (AFM) and to investigate its clinical features and short-term outcomes.
Methods: We performed a retrospective chart review of all children <18 years old who were diagnosed with AFM between October 2008 and February 2013. Data about patient demographics, initial symptoms, investigation results, management, and outcomes between survivors and nonsurvivors were collected.
Results: Seventeen of 21 patients (80.9%) with myocarditis were diagnosed with AFM. Eleven patients (64.7%) survived to discharge, and 6 (35.3%) died. Electrocardiography on admission revealed dysrhythmia in 10 patients (58.8%); of these, all 7 patients with a complete atrioventricular block survived. Fractional shortening upon admission was significantly different between the survivors (16%) and nonsurvivors (8.5%) (P =0.01). Of the serial biochemical markers, only the initial brain natriuretic peptide (P =0.03) and peak blood urea nitrogen levels (P =0.02) were significantly different. Of 17 patients, 4 (23.5%) required medical treatment only. Extracorporeal membrane oxygenation (ECMO) was performed in 13 patients (76.5%); the survival rate in these patients was 53.8%. ECMO support was initiated >24 hours after admission in 4 of the 13 patients (30.7%), and 3 of those 4 patients (75%) died.
Conclusion: AFM outcomes may be associated with complete atrioventricular block upon hospital admission, left ventricular fractional shortening at admission, time from admission to the initiation of ECMO support, initial brain natriuretic peptide level, and peak blood urea nitrogen level.
Keywords: Myocarditis | Extracorporeal membrane oxygenation | Child | Outcomes
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