EXPERIENCE IN THE OBSERVATION OF ACUTE AND FULMINANT MYOCARDITIS IN CHILDREN

The results of observation of 17 patients aged 2 monthsto 16 years with acute and fulminant myocarditis(FM) were analyzed. Patients were observed in the period 2013-2016. Diagnostics used clinical data, laboratory and instrumental studies. Of 17 patients, acute myocarditis was diagnosed in 14 children, fulminant in 3. Therapy included, first of all, measures for the treatment of heart failure – diuretics (furosemide, verospiron, triampur), angiotensin converting enzyme (ACE) inhibitors (captopril), beta-blockers, digoxin inotropic agents. Intravenous human immunoglobulin was administered at a dose of 1-2 g/kg/course in 5 of 17 (29.4%) patients. When the pathogen was verified, specific antiviral therapy (acyclovir, ganciclovir, cymevene) was administered in a standard mode. Immunosuppressive therapy (prednisolone, delagil) was prescribed for two of them. Nonsteroidal anti-inflammatory drugs (ibuprofen, diclofenac) was obtained in children with acute myocarditis duration of over 2 weeks (13 children) prior to 2016. Nonsteroidal antiinflammatory drugs were not administered to hemodynamically unstable patients, regardless of the time period of observation. Overall, 16 out of 17 (94.4%) patients recovered with apparent regression of signs of myocarditis on the background of treatment – the symptoms of acute heart failure and cardiogenic shock were treated, and then manifestations of chronic congestive heart failure gradually decreased. 1 (5,6%) child with fulminant myocarditis died. After 6 months to 3 years, 14 children were observed. Follow-up within 6 months to 3 years showed that the diameter of the left ventricle normalized in 10 out of 14 (71.4%). Two out of 14 children (14.3%) formed postmyocardial dilated cardiomyopathy.

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