Clinical Characteristics And Prognosis Of 31 Children With Fulminant Myocarditis

Background: Analysis of clinical features and prognosis of children with fulminant myocarditis,provide the basis for clinical diagnosis and treatment.Methods: The patients were chosen hospitalized in the Shengjing Hospital,China Medical University PICU diagnosis of fulminant myocarditis in children from Jan.2012 to Dec.2017.Their medical data was retrospectively analyzed,including sex,age,clinical manifestations,changes of electrocardiogram(ECG)and myocardial enzyme,With or without mechanical adjuvant therapy and outcome of disease and its prognosis.Results: Among 31 cases,there were 9 male cases and 22 female ones.Their median age are 7.69 years(1 month old to 13 years old).The most common first symptom was the Circulation system(like palpitations,chest pain,hypotension and more)and it was 48.4%(15/31).About half of the first symptom outside the circulation system.The nervous system(like headache,dizziness,drowsiness,convulsions and more)was 29.0%(9/31)in the second place.Next the digestive system(like nausea,vomiting,abdominal pain and more)was 16.1%(5/31)and Respiratory system(like fever,cough,breathing difficulties and more)was 6.5%(2/31).Most children had multiple systems involved in performance at the same time.The myocardial enzymes were detected in 31 cases.And there were 93.5%(29/31)cases with increase of CK and all children with raised CKMB.93.5%(29/31)cases had increased CKMB Isoenzyme quality and 96.8%(30/31)cases had increased tropoint I.The raised BNP and NT-pro BNP were both found in 12 cases.There were 82.1%(23/28)cases having increased blood lactate.All children recevied conventional treatments like myocardial nutrition,anti-viral et al.Among these children,96.8%(30/31)were applied hormones and 87.1%(27/31)were treated with human gamma globulin.At the same time,the children were given with the therapies of antishock,anti-arrhythmia,correcting heart failure,mechanical aids and other comprehensive treatment.Only one case with III degree atrioventricular block were implanted temporary pacemaker and three cases were treated with extra-corporeal membrane oxygenation(ECMO).45.2%(14/31)cases were discharged with a better health condition and 17(54.8%)died.Fourteen children in survival group were followed up for a range of half months to two years.Eight children were completely improved,and one died,and one lost follow-up,and four still needed medication.Conclusion: The fulminant myocarditis has high mortality in the acute phase and multiple first symptom manifestations.The vast majority of patients had high myocardial enzyme and abnormal ECG.The most of children with active treatment had a good long-term prognosis.With the improvement of diagnosis and treatment technology in recent years,such as the application of ECMO,the survival rate will be greatly enhanced.