Respiratory Syncytial Virus Associated Myocarditis Requiring Venoarterial Extracorporeal Membrane Oxygenation

Milas, Anamaria; Shah, Aditya; Anand, Nikhil; Saunders-Kurban, Meghan; Patel, Samir R.

doi:10.1155/2017/7074508

Cited by 5 publications

(6 citation statements)

References 7 publications

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“…Therefore, elevated levels of these enzymes have also been observed in cases of mild PH and RV strain in primary respiratory diseases. The presence of myocardial damage in AB has been documented in case reports of severely ill and ventilated infants with MD cataloged as myocarditis [17,54,61]. Consistently, this elevation of cardiac troponin has been consistently observed by most of the authors that assessed myocardial injury in the studies included in this systematic review.…”

Section: Cardiac Troponinsupporting

confidence: 70%

“…It is remarkable that no cases of severe pericardial effusion or left ventricular systolic dysfunction and left ventricular dilation have been found in this systematic review. These findings have been previously reported highlighting the possibility of the occurrence of myocarditis in infants with AB [17,53,54]. However, it has only been reported in case reports and, therefore, these incidental findings would not be a representative picture of the MS in AB.…”

Section: Myocardial Dysfunctionsupporting

confidence: 55%

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The Assessment of Myocardial Strain by Cardiac Imaging in Healthy Infants with Acute Bronchiolitis: A Systematic Review and Meta-Analysis

et al. 2020

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This study aims to systematically review the incidence of myocardial strain detected by echocardiography in previously healthy infants with acute bronchiolitis and its role as a predictor for adverse outcomes in this setting. Methods: Pubmed/Medline, Excerpta Medica Data Base (EMBASE), and Cochrane Library were searched in April 2020 to identify original observational prospective studies that systematically performed echocardiography for the screening of myocardial strain in healthy infants with acute bronchiolitis. Pooled estimates were generated using random-effects models. Heterogeneity within studies was assessed using Cochran’s Q and I2 statistics. Funnel plots and Egger´s regression method were constructed to evaluate publication bias. Sensitivity analyses were also conducted to evaluate potential sources of heterogeneity. Results: After a detailed screening of 305 articles, a total of 10 studies with 395 participants (mean of 40 participants per study) was included. Five of them were classified as high-quality studies. Up to 28% of cases presented adverse outcomes. The echocardiographic screening for myocardial strain was performed within the first 24 h of admission in 92% cases. Tissue Doppler imaging and Speckle-Tracking echocardiography were performed only in 20% of cases. The presence of pulmonary hypertension was evaluated with methods different from the tricuspid regurgitation jet in 64% of cases. Seven studies found some grade of myocardial strain with a pooled incidence of 21% (CI 95%, 11–31%), in the form of pulmonary hypertension (pooled incidence of 20% (CI 95%, 11–30%)), and myocardial dysfunction (pooled incidence of 5% (CI 95%, 1–9%)). The presence of these echocardiographic alterations was associated with adverse outcomes (pooled relative risk = 16; CI 95%, 8.2–31.5). After a subgroup analysis based on the echocardiographic techniques used, no significant heterogeneity across the studies was observed. There was no evidence of publication bias when assessed by Egger´s test. Cardiac biomarkers to assess myocardial strain were used in five studies. Only N-terminal-pro-brain natriuretic peptide accurately predicted the presence of myocardial strain by echocardiography. Conclusions: Myocardial strain is not infrequent in previously healthy infants with acute bronchiolitis, and it could be present at the early stages of the disease with prognostic implications. There is a need for sufficiently powered prospective studies with a similar methodology, preferably employing advanced imaging techniques, to conclusively address the usefulness of the assessment of myocardial strain in this setting.

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Section: Cardiac Troponinsupporting

confidence: 70%

Section: Myocardial Dysfunctionsupporting

confidence: 55%

The Assessment of Myocardial Strain by Cardiac Imaging in Healthy Infants with Acute Bronchiolitis: A Systematic Review and Meta-Analysis

et al. 2020

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“…A study utilizing the ELSO database from 1995 through 2011 included 147 patients with a diagnosis of acute myocarditis who underwent ECMO support and showed a survival to hospital discharge rate of 61% ( 86 ). Many other groups have reported similarly high weaning and hospital discharge rates, establishing VA-ECMO as an extremely effective strategy for the management of patients with fulminant myocarditis associated with hemodynamic collapse ( 87 – 100 ) ( Table 2 ).…”

Section: Common Indications For Va-ecmo Supportmentioning

confidence: 92%

Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock

Tsangaris

Alexy

Kalra

et al. 2021

Front. Cardiovasc. Med.

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Cardiogenic shock accounts for ~100,000 annual hospital admissions in the United States. Despite improvements in medical management strategies, in-hospital mortality remains unacceptably high. Multiple mechanical circulatory support devices have been developed with the aim to provide hemodynamic support and to improve outcomes in this population. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is the most advanced temporary life support system that is unique in that it provides immediate and complete hemodynamic support as well as concomitant gas exchange. In this review, we discuss the fundamental concepts and hemodynamic aspects of VA-ECMO support in patients with cardiogenic shock of various etiologies. In addition, we review the common indications, contraindications and complications associated with VA-ECMO use.

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“…RSV myocarditis is a well-known extrapulmonary manifestation of severe RSV infection [18]. Although RSV has been detected in human myocardial tissue on PCR [19], the occurrence of cardiogenic shock resulting primarily from heart failure has rarely been documented [20, 21]. Myocardial dysfunction seems a more common clinical picture, notably in infants or in children with congenital heart disease [22–25].…”

Section: Discussionmentioning

confidence: 99%

Respiratory syncytial virus-associated mortality in a healthy 3-year-old child: a case report

et al. 2019

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Background: Respiratory syncytial virus (RSV) is the most frequently identified pathogen in children with acute lower respiratory tract infection. Fatal cases have mainly been reported during the first 6 months of life or in the presence of comorbidity. Case presentation: A 47-month-old girl was admitted to the pediatric intensive care unit following sudden cardiopulmonary arrest occurring at home. The electrocardiogram showed cardiac asystole, which was refractory to prolonged resuscitation efforts. Postmortem analyses detected RSV by polymerase chain reaction in an abundant, exudative pericardial effusion. Histopathological examination was consistent with viral myoepicarditis, including an inflammatory process affecting cardiac nerves and ganglia. Molecular analysis of sudden unexplained death genes identified a heterozygous mutation in myosin light chain 2, which was also found in two other healthy members of the family. Additional expert interpretation of the cardiac histology confirmed the absence of arrhythmogenic right ventricular dysplasia or hypertrophic cardiomyopathy. Conclusions: RSV-related sudden death in a normally developing child of this age is exceptional. This case highlights the risk of extrapulmonary manifestations associated with this infection, particularly arrhythmia induced by inflammatory phenomena affecting the cardiac autonomic nervous system. The role of the mutation in this context is uncertain, and it is therefore necessary to continue to assess how this pathogenic variant contributes to unexpected sudden death in childhood.

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Respiratory Syncytial Virus Associated Myocarditis Requiring Venoarterial Extracorporeal Membrane Oxygenation

Cited by 5 publications

References 7 publications

The Assessment of Myocardial Strain by Cardiac Imaging in Healthy Infants with Acute Bronchiolitis: A Systematic Review and Meta-Analysis

The Assessment of Myocardial Strain by Cardiac Imaging in Healthy Infants with Acute Bronchiolitis: A Systematic Review and Meta-Analysis

Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock

Respiratory syncytial virus-associated mortality in a healthy 3-year-old child: a case report

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