Abstract
OBJECTIVES--To assess the diagnostic yield, sampling errors, risks, and therapeutic implications of right ventricular endomyocardial biopsy in children with suspected or possible myocarditis. DESIGN--Retrospective study. SETTING--Tertiary referral centre for paediatric cardiology, cardiac surgery, heart transplantation, and mechanical circulatory support. PATIENTS AND METHODS--Review of clinical and histological findings among 63 consecutive children with possible myocarditis undergoing right ventricular endomyocardial biopsy. Review of cardiac histology at subsequent necropsy or after explantation at time of transplantation. RESULTS--From January 1980 to December 1992, 76 biopsies were performed in 63 children (2 weeks to 18 years of age). In 41 cases, the biopsy was performed for evaluation of dilated cardiomyopathy. The median interval from onset of symptoms was one month. Eight children (20%; all with a history of less than six weeks duration) had biopsy proved myocarditis. Five of the eight children made a full recovery, including four who presented in cardiogenic shock. By contrast, only three of 33 children without evidence of myocarditis showed recovery of ventricular function. The whole heart was available for histological examination in 23 patients. Myocarditis was confirmed in one patient, and no evidence of myocarditis was found in the remaining 22 (all with negative biopsies). One procedure related death occurred in a 2 week old infant with dilated cardiomyopathy. In 22 cases, biopsy was performed for the evaluation of arrhythmia. Only one biopsy showed myocarditis. CONCLUSIONS--The diagnostic yield of a biopsy is low in children with arrhythmias. In children presenting with profound ventricular dysfunction, a diagnosis of acute myocarditis may avoid premature consideration of transplantation as this group has an important potential for full recovery. In less critically ill patients and in those with a longer duration of symptoms the justification for biopsy is not as clear and the procedure is not without risk.
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- Aretz H. T., Billingham M. E., Edwards W. D., Factor S. M., Fallon J. T., Fenoglio J. J., Jr, Olsen E. G., Schoen F. J. Myocarditis. A histopathologic definition and classification. Am J Cardiovasc Pathol. 1987 Jan;1(1):3–14. [PubMed] [Google Scholar]
- Chan K. Y., Iwahara M., Benson L. N., Wilson G. J., Freedom R. M. Immunosuppressive therapy in the management of acute myocarditis in children: a clinical trial. J Am Coll Cardiol. 1991 Feb;17(2):458–460. doi: 10.1016/s0735-1097(10)80115-9. [DOI] [PubMed] [Google Scholar]
- Davies M. J., Ward D. E. How can myocarditis be diagnosed and should it be treated? Br Heart J. 1992 Oct;68(4):346–347. doi: 10.1136/hrt.68.10.346. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Leatherbury L., Chandra R. S., Shapiro S. R., Perry L. W. Value of endomyocardial biopsy in infants, children and adolescents with dilated or hypertrophic cardiomyopathy and myocarditis. J Am Coll Cardiol. 1988 Dec;12(6):1547–1554. doi: 10.1016/s0735-1097(88)80024-x. [DOI] [PubMed] [Google Scholar]
- Lewis A. B., Neustein H. B., Takahashi M., Lurie P. R. Findings on endomyocardial biopsy in infants and children with dilated cardiomyopathy. Am J Cardiol. 1985 Jan 1;55(1):143–145. doi: 10.1016/0002-9149(85)90316-9. [DOI] [PubMed] [Google Scholar]
- Martin A. B., Webber S., Fricker F. J., Jaffe R., Demmler G., Kearney D., Zhang Y. H., Bodurtha J., Gelb B., Ni J. Acute myocarditis. Rapid diagnosis by PCR in children. Circulation. 1994 Jul;90(1):330–339. doi: 10.1161/01.cir.90.1.330. [DOI] [PubMed] [Google Scholar]
- Schmaltz A. A., Apitz J., Hort W., Maisch B. Endomyocardial biopsy in infants and children: experience in 60 patients. Pediatr Cardiol. 1990 Jan;11(1):15–21. doi: 10.1007/BF02239542. [DOI] [PubMed] [Google Scholar]
- Starling R. C., Van Fossen D. B., Hammer D. F., Unverferth D. V. Morbidity of endomyocardial biopsy in cardiomyopathy. Am J Cardiol. 1991 Jul 1;68(1):133–136. doi: 10.1016/0002-9149(91)90729-5. [DOI] [PubMed] [Google Scholar]
- Wiles H. B., Gillette P. C., Harley R. A., Upshur J. K. Cardiomyopathy and myocarditis in children with ventricular ectopic rhythm. J Am Coll Cardiol. 1992 Aug;20(2):359–362. doi: 10.1016/0735-1097(92)90102-s. [DOI] [PubMed] [Google Scholar]