Clinicopathological features of paediatric deaths due to myocarditis: an autopsy series

Weber, MA; Ashworth, Michael; Risdon, R. A.; Malone, Marian; Burch, Michael; Sebire, Neil J.

doi:10.1136/adc.2007.128686

Cited by 78 publications

(45 citation statements)

References 26 publications

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“…4,17,21,[23][24][25] The mean and median ages of patients with myocarditis were 5.4 and 5 years, respectively, which confirms that myocarditis is more likely to cause SUCD in older children. This is in accordance with the findings of Weber et al 25 In our series, conventional histopathological criteria were used to establish the diagnosis of myocarditis. 16,26 Reports have demonstrated limitations of the light-microscopy criteria (the Dallas criteria), pointing out that milder inflammatory changes may go undetected.…”

Section: Myocardial Disorderssupporting

confidence: 52%

Undiagnosed Heart Disease Leading to Sudden Unexpected Death in Childhood: A Retrospective Study

Ilina¹,

Kepron

Taylor

et al. 2011

Pediatrics

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OBJECTIVES: Heart disease accounts for a significant proportion of sudden unexpected deaths among children. We describe here demographic features, pathological conditions, and the frequency of premonitory symptoms in a retrospective series of cases of sudden unexpected cardiac death (SUCD) attributable to undiagnosed structural heart disease. METHODS: A chart review of autopsies involving children 0 to 17 years of age that were performed at the Hospital for Sick Children (Toronto, Ontario, Canada) between 1984 and 2003 was conducted. Cases of sudden unexpected death within 24 hours after clinical presentation with previously undetected fatal heart disease were included. Cases with multiple or thoracic trauma and chronic or multisystem disease were excluded. RESULTS: During the 20-year study period, 4926 autopsies were performed. A total of 103 cases (2.1%), involving 51 male patients and 52 female patients 1 day to 15 years of age (mean: 2.9 ± 4.2 years), were diagnosed as having SUCD. The most common diagnoses were myocarditis (n = 37 [35.9%]), hypoplastic left heart syndrome (HLHS) (n = 19 [18.4%]), dilated cardiomyopathy (DCM) (n = 16 [16.5%]), coronary artery anomalies (n = 6 [5.8%]), and aortic stenosis (n = 5 [4.9%]). There was a significant difference in the mean age of presentation between leading causes of SUCD (6.5 days for HLHS, 1.7 years for DCM, and 5.4 years for myocarditis; P < .0001). Of 103 cases, 27 (26.2%) had premonitory symptoms documented. CONCLUSION: SUCD accounted for 2.1% of all autopsies, and HLHS, DCM, and myocarditis were the 3 most common diagnoses, which presented at increasing ages.

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Section: Myocardial Disorderssupporting

confidence: 52%

Undiagnosed Heart Disease Leading to Sudden Unexpected Death in Childhood: A Retrospective Study

Ilina¹,

Kepron

Taylor

et al. 2011

Pediatrics

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“…Myocarditis may present clinically with a range of symptoms and is increasingly implicated as a cause of sudden death in infancy and childhood. A recent study of autopsies in a United Kingdom hospital reported myocarditis as the cause of death in approximately 2% of the deaths of children Ͻ18 years old, 57% of which were sudden deaths (16,17).…”

Section: Case Reportmentioning

confidence: 99%

First Report of Sudden Death Due to Myocarditis Caused by Adenovirus Serotype 3

et al. 2010

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Myocarditis is a rare cause of sudden death in childhood. We describe the sudden death of a child from viral myocarditis, which we demonstrate was likely caused by an uncontrolled inflammatory response to a disseminated adenovirus serotype 3 infection originating in the tonsil. CASE REPORTAn 11-year old boy collapsed suddenly at home. He was transferred to a hospital by ambulance. Cardiopulmonary resuscitation was unsuccessful, and he was pronounced dead. He had visited his general practitioner (GP) 1 day earlier with a sore throat and was treated with antibiotics for tonsillitis. No investigations were carried out by his GP or on arrival at the hospital due to his sudden death. He had no past medical history of note, and there was no family history of cardiac illness or sudden death. No recent foreign travel was reported, nor was there contact with persons from abroad. A postmortem was carried out at the direction of the coroner.Much of the postmortem examination was normal. His tonsils were mildly enlarged and showed a surface purulent exudate. However, on postmortem examination, his heart was enlarged (weight, 214.2 g; expected weight, 124 g). On sectioning, the myocardium appeared diffusely abnormal with areas of petechiae and pallor. There was no evidence of myocardial hypertrophy. Microscopically, there was a severe myocardial infiltrate diffusely present composed of lymphocytes, histiocytes, and plasma cells with occasional eosinophils and neutrophils (Fig. 1). There were admixed areas of necrosis and hemorrhage. There was no evidence of fibrosis or myofiber hypertrophy. Immunohistochemical staining revealed that the infiltrate was predominantly lymphohistiocytic (CD45 positive). CD3 staining confirmed that this was a T-lymphocytemediated response (Fig. 2).All routine investigations, including swabs for bacterial culture, blood cultures, meningococcal PCR, and pneumococcal PCR, were negative. Toxicology testing for alcohol and drugs was negative. Target-specific immunoglobulin M assays were performed for Mycoplasma pneumoniae, cytomegalovirus, Epstein-Barr virus, parvovirus B19, and rubella virus, along with complement fixation testing for total antibodies to Mycoplasma pneumoniae, Chlamydia group, and adenovirus and latex agglutination testing for Toxoplasma gondii. All serological investigations were negative. In addition, no viruses were observed in the lung or myocardial tissue by electron microscopy. Cerebrospinal fluid Gram staining and culture were negative.The most common viral etiologies of myocarditis are Coxsackie group B viruses and members of the adenovirus genus (3, 5). Therefore, molecular methods were employed to investigate the presence of these viruses. Total viral RNA/DNA was extracted from serum using the Qiagen QIAmp viral RNA mini kit, and total viral DNA was extracted from myocardial and pulmonary tissue using the QIAamp DNA mini kit (Qiagen) in accordance with the manufacturer's instructions. Enterovirus RNA was not detected in lung or myocardial tissue using a nested reverse trans...

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“…Of these, 5 infants were recruited from the MICU, 6 were recruited from the ICP, and 4 from the Inpatient Units. There were 10 males and 5 females with a median age of 2.0 (0.4-18) months, median weight of 5.8 (3)(4)(5)(6)(7)(8)(9)(10)(11) kg and median height of 60 (50-84) cm. Median time to acute stabilization was 4 (1-6) days, time between initial and final CO recording was 2.5 (0.8-7.2) days and length of hospitalization was 3.6 (1.6-8.9) days.…”

Section: Resultsmentioning

confidence: 99%

“…Infants with respiratory insufficiency from bronchiolitis may have similar clinical features to infants with congestive heart failure [7], presenting with irritability, fever, tachypnea, tachycardia and a mottled appearance. Although RSV infection seldom causes myocarditis, early detection of impaired cardiac output (CO) can be lifesaving in these infants [8] and similar to other etiologies for myocarditis may require emergent referral for advanced hemodynamic support (e.g., ECMO and heart [9,10]. Consequently, it is important to have the ability to monitor cardiac function in infants with RSV bronchiolitis in order to ensure optimal clinical management.…”

Section: Introductionmentioning

confidence: 99%

Changes in cardiac output and stroke volume as measured by non-invasive CO monitoring in infants with RSV bronchiolitis

Caplow

McBride

Steil

et al. 2012

J Clin Monit Comput

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Clinicopathological features of paediatric deaths due to myocarditis: an autopsy series

Abstract: Myocarditis is a rare cause of death in infancy and childhood, and the majority of cases present as sudden unexpected deaths, which require routine histological sampling of the heart for its detection.

Cited by 78 publications

References 26 publications

Undiagnosed Heart Disease Leading to Sudden Unexpected Death in Childhood: A Retrospective Study

Undiagnosed Heart Disease Leading to Sudden Unexpected Death in Childhood: A Retrospective Study

First Report of Sudden Death Due to Myocarditis Caused by Adenovirus Serotype 3

Changes in cardiac output and stroke volume as measured by non-invasive CO monitoring in infants with RSV bronchiolitis

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