A staged strategy of left atrial decompression and pulmonary artery banding in young children with myocarditis-associated DCM resulted in 90% overall survival and 76% sustained functional recovery.
Cohort (n=31)
Does a staged strategy combining left atrial decompression and pulmonary artery banding improve survival and myocardial recovery in young children with myocarditis-associated DCM?
A staged strategy of left atrial decompression and pulmonary artery banding is associated with a 90% overall survival and promotes myocardial recovery in young children with myocarditis-associated dilated cardiomyopathy.
BACKGROUND: Myocarditis progressing to a dilated cardiomyopathy (DCM) phenotype carries a high risk of end-stage heart failure in early childhood. OBJECTIVES: Given the age-dependent regenerative capacity of the immature myocardium, we evaluated a staged, pathophysiology-guided strategy combining left atrial decompression and pulmonary artery banding (PAB) to promote myocardial recovery in selected infants and young children. METHODS: We retrospectively analyzed 31 children III; median BNP was 2,258 pg/mL (IQR: 770-4331), and 90% required inotropic support. The mean echocardiography-derived left ventricular (LV) ejection fraction at admission was 24% ± 6.2% with marked LV dilatation (mean z-score +5). The median LV end-diastolic pressure (was 20 mm Hg (IQR: 15-23), indicating elevated filling pressures. A restrictive atrial communication (restrictive atrial septal defect or patent foramen ovale dilatation) was created in 17 patients for atrial decompression. Seventeen patients met the predefined criteria for surgical PAB, including severely reduced LV ejection fraction (mean 19% ± 6%), marked LV dilatation (z-score +6 ± 1.6), and preserved right ventricular function. During a median follow-up of 2 years (IQR: 1-7) overall survival was 90%. Heart transplantation was required in 19%; mechanical circulatory support in 6%. Among patients selected for PAB, 76% achieved sustained functional recovery. CONCLUSIONS: A staged, pathophysiology-guided strategy incorporating left atrial decompression and PAB may promote myocardial recovery in selected young children with myocarditis-associated DCM.
Logeswaran et al. (Fri,) conducted a cohort in Myocarditis with DCM phenotype (n=31). Left atrial decompression and pulmonary artery banding (PAB) was evaluated on Overall survival. A staged strategy of left atrial decompression and pulmonary artery banding in young children with myocarditis-associated DCM resulted in 90% overall survival and 76% sustained functional recovery.