Author Of 1 Presentation
ACUTE SEVERE MYOCARDITIS WITH EXTENSIVE CARDIAC THROMBUS FORMATION IN A TEENAGE BOY: A THERAPEUTIC CHALLENGE
Abstract
Background
Acute myocarditis is a rare condition in pediatrics, but potentially lethal, that can culminate in cardiac disfunction and, rarely, intracardiac thrombus.
Objectives
Not Applicable
Methods
Not Applicable
Results
We report the case of a 16-year-old teenage male, previously healthy, that was transfered to the Pediatric Intensive Care Unit due to suspicion of acute myocarditis with multiorgan disfunction. Echocardiogram at admission revealed moderate to severe left ventricular (LV) disfunction (ejection fraction of 30-35%) and two hyperechoic masses in the LV suggestive of thrombus, given which he initiated non-fractionated heparin. The cardiac magnetic resonance at day 4 was compatible with acute myocarditis with moderate to severe ventricular disfunction and biventricular thrombus. Of the infectious investigation, the only relevant finding was a positive fecal culture for Campylobacter jejuni; remaining microbiological, immunological, and prothrombotic studies were negative. Despite the treatmentwith ceftriaxone, azithromycin and IV immunoglobulin, there was an increase of the thrombus, with decline of cardiac function and peripheric arterial embolization, which led to surgical thrombectomy on day 13. He was maintained on extracorporeal membrane oxygenation until day 28, when he was subjected to orthotopic cardiac transplant with no complications. Evolution was favorable, with progressive improvement of cardiac function and no recurrence of thrombus.
Conclusion
We present a case of acute myocarditis complicated with intracardiac thrombus and systemic embolization. The approach to these cases should be multifactorial and multidisciplinary and the decision of surgical treatment is difficult. Despite severe cardiac dysfunction and intraoperative risk of embolization, the surgery was successful and should be considered in the absence of improvement with medical treatment.