ppharmПедиатрическая фармакологияPediatric pharmacology1727-57762500-3089Издательство «ПедиатрЪ»10.15690/pf.v17i2.2100ppharm-1838Research ArticleЛЕКЦИЯLECTUREМиокардиты у детей: клиническая картина, диагностика и лечениеMyocarditis in Children: Clinical Overview, Diagnosis and Treatmenthttps://orcid.org/0000-0002-2290-0013БалыковаЛ. А.BalykovaLarisa A.

Балыкова Лариса Александровна, доктор медицинских наук, профессор, член-корреспондент РАН, заведующая кафедрой педиатрии, директор медицинского института ФГБОУ ВО «МГУ им. Н.П. Огарёва»

430005, Саранск, ул. Советская, д. 50-14, тел.: +7 (8342) 32-19-83

Saransk

larisabalykova@yandex.ruhttps://orcid.org/0000-0003-3990-9353КраснопольскаяА. В.KrasnopolskayaAnna V.

Саранск

Saransk

https://orcid.org/0000-0002-4238-1863ВласоваЕ. А.VlasovaEkaterina A.

Саранск

Saransk

Мордовский государственный университет им. Н.П. ОгарёваРоссияN.P. Ogarev Mordovia State UniversityRussian Federation202010062020172137147Copyright © Балыкова Л.А., Краснопольская А.В., Власова Е.А., 20202020Балыкова Л.А., Краснопольская А.В., Власова Е.А.Balykova L.A., Krasnopolskaya A.V., Vlasova E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pedpharma.ru/jour/article/view/1838

В лекции представлены современные взгляды на проблему миокардитов в детском возрасте. Приведены актуальные сведения о распространенности, этиологии и патогенезе воспалительных поражений миокарда у детей. В соответствии с федеральными клиническими рекомендациями раскрыты особенности проявления симптомов заболевания у пациентов разных возрастных групп, трудности диагностики и лечения миокардита и его осложнений. Особое внимание уделено согласованным Европейским обществом кардиологов диагностическим подходам, в том числе методикам первого и второго уровня, определению показаний к их проведению и диагностическим возможностям, а также дифференциальному диагнозу миокардитов с другими кардиологическими заболеваниями. Обсуждаются вопросы лечения сердечной недостаточности при миокардитах и показания к проведению трансплантации сердца лицам в возрасте до 18 лет. Лекция проиллюстрирована результатами собственных наблюдений, наглядно демонстрирующими разнообразие клинической картины и неоднозначность прогноза миокардита у детей и подростков.

The lecture presents modern views on the problem of myocarditis in pediatrics. Current ideas about the definition, prevalence, etiology and pathogenesis of inflammatory myocardial lesions in children are presented. Features of clinical manifestations of the disease in patients of different age groups, difficulties of diagnosis and treatment of myocarditis and its complications are disclosed in accordance with federal clinical recommendations. Special attention is paid to diagnostic approaches adjusted with the European society of cardiologists, including first and second level techniques, determination of indications for their implementation and diagnostic capabilities, as well as differential diagnosis of myocarditis with other cardiological diseases. Issues of heart failure treatment in myocarditis and indications for heart transplantation for patients under 18 years of age were also discussed. The lecture has illustrated clinical examples that clearly demonstrate the diversity of the clinical picture and the ambiguity of myocarditis prognosis in children and teenagers.

детимиокардитсердечная недостаточностьchildrenmyocarditisheart failureОтсутствует.Not specified.ReferencesCaforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on etiology, diagnosis, management, and therapy of myocarditis: a position statement of the European society of cardiology working group on myocardial and pericardial diseases. Eur Heart J. 2013;34(33):2636–2648. doi: 10.1093/eurheartj/eht210.Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on etiology, diagnosis, management, and therapy of myocarditis: a position statement of the European society of cardiology working group on myocardial and pericardial diseases. Eur Heart J. 2013;34(33):2636–2648. doi: 10.1093/eurheartj/eht210.Richardson P, McKenna W, Bristow M, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation. 1996;93:841–842.Richardson P, McKenna W, Bristow M, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation. 1996;93:841–842.Терещенко С.Н. Диагностика и лечение миокардитов. Клинические рекомендации. — М., 2019. — 47 с.Tereschenko SN. Diagnostika i lechenie miokarditov. Klinicheskie rekomendatsii. Moscow; 2019. 47 p. (In Russ).Heymans S, Eriksson U, Lentonen J, Cooper LT Jr. The quest for new approaches myocarditis and inflammatory cardiomyopathy. J Am Coll Cardiol. 2016;68(21):2348–2364. doi: 10.1016/j.jacc.2016.09.937.Heymans S, Eriksson U, Lentonen J, Cooper LT Jr. The quest for new approaches myocarditis and inflammatory cardiomyopathy. J Am Coll Cardiol. 2016;68(21):2348–2364. doi: 10.1016/j.jacc.2016.09.937.Li L, Zhang Y, Burke A, et al. Demographic, clinical and pathological features of sudden deaths due to myocarditis: results from a state-wide population-based autopsy study. Forensic Sci Int. 2017;272:81–86. doi: 10.1016/j.forsciint.2016.Li L, Zhang Y, Burke A, et al. Demographic, clinical and pathological features of sudden deaths due to myocarditis: results from a state-wide population-based autopsy study. Forensic Sci Int. 2017;272:81–86. doi: 10.1016/j.forsciint.2016.Masarone D, Valente F, Rubino M, et al. Pediatric heart failure: a practical guide to diagnosis and management. Pediatr Neonatol. 2017;58(4):303–312. doi: 10.1016/j.pedneo.2017.01.001.Masarone D, Valente F, Rubino M, et al. Pediatric heart failure: a practical guide to diagnosis and management. Pediatr Neonatol. 2017;58(4):303–312. doi: 10.1016/j.pedneo.2017.01.001.Canter CE, Simpson KE. Diagnosis and treatment of myocarditis in children in the current era. Circulation. 2014;129(1):115–128. doi: 10.1161/CIRCULATIONAHA.113.001372.Canter CE, Simpson KE. Diagnosis and treatment of myocarditis in children in the current era. Circulation. 2014;129(1):115–128. doi: 10.1161/CIRCULATIONAHA.113.001372.Gore I, Saphir O. Myocarditis: a classification of 1402 cases. Am Heart J. 1947;34:827–830.Gore I, Saphir O. Myocarditis: a classification of 1402 cases. Am Heart J. 1947;34:827–830.Basso C, Calabrese F, Corrado D, Thiene G. Postmortem diagnosis in sudden cardiac death victims: macroscopic, microscopic and molecular findings. Cardiovasc Res.2001;50:290–300.Basso C, Calabrese F, Corrado D, Thiene G. Postmortem diagnosis in sudden cardiac death victims: macroscopic, microscopic and molecular findings. Cardiovasc Res.2001;50:290–300.Vetter VL, Covington TM, Dugan NP, et al. Cardiovascular deaths in children: general overview from the National Center for the Review and Prevention of Child Deaths. Am Heart J. 2015;169(3):426–437. e23. doi: 10.1016/j.ahj.2014.11.014.Vetter VL, Covington TM, Dugan NP, et al. Cardiovascular deaths in children: general overview from the National Center for the Review and Prevention of Child Deaths. Am Heart J. 2015;169(3):426–437. e23. doi: 10.1016/j.ahj.2014.11.014.Клинические рекомендации по детской кардиологии и ревматологии / Под ред. М.А. Школьниковой, Е.И. Алексеевой. — М., 2011. — 512 с.Klinicheskie rekomendatsii po detskoi kardiologii i revmatologii. Ed by M.A. Shkolnikova, E.I. Alekseeva. Moscow; 2011. 512 р. (In Russ).Садыкова Д.И. Принципы медикаментозной терапии миокардитов у детей // Вестник современной клинической медицины. — 2013. — T.6. — №3. — С. 54–60.Sadykova DI. Principles of medical therapy of myocarditis in children. Bulletin of contemporary clinical medicine. 2013;6(3):54–60. (In Russ).Rodriguez-Gonzalez M, Sanchez-Codez MI, Lubian-Gutierrez M, Castellano-Martinez A. Clinical presentation and early predictors for poor outcomes in pediatric myocarditis: a retrospective study. World J Clin Cases. 2019;7(5):548–561. doi: 10.12998/wjcc.v7.i5.548.Rodriguez-Gonzalez M, Sanchez-Codez MI, Lubian-Gutierrez M, Castellano-Martinez A. Clinical presentation and early predictors for poor outcomes in pediatric myocarditis: a retrospective study. World J Clin Cases. 2019;7(5):548–561. doi: 10.12998/wjcc.v7.i5.548.Van Linthout S, Tschope C. Viral myocarditis: a prime example for endomyocardial biopsy-guided diagnosis and therapy. Curr Opin Cardiol. 2018;33(3):325–333. doi: 10.1097/HCO.0000000000000515.Van Linthout S, Tschope C. Viral myocarditis: a prime example for endomyocardial biopsy-guided diagnosis and therapy. Curr Opin Cardiol. 2018;33(3):325–333. doi: 10.1097/HCO.0000000000000515.Chang YJ, Hsiao HJ, Hsia SH, et al. Analysis of clinical parameters and echocardiography as predictors of fatal pediatric myocarditis. PLoS One. 2019;14(3):e0214087. doi: 10.1371/journal.pone.0214087.Chang YJ, Hsiao HJ, Hsia SH, et al. Analysis of clinical parameters and echocardiography as predictors of fatal pediatric myocarditis. PLoS One. 2019;14(3):e0214087. doi: 10.1371/journal.pone.0214087.Lieberman EB, Hutchins GM, Herskowitz A, et al. Clinicopathologic description of myocarditis. J Am Coll Cardiol. 1991;18(7):1617–1626.Lieberman EB, Hutchins GM, Herskowitz A, et al. Clinicopathologic description of myocarditis. J Am Coll Cardiol. 1991;18(7):1617–1626.Amabile N, Fraisse A, Bouvenot J, et al. Outcome of acute fulminant myocarditis in children. Heart. 2006;92(9):1269–1273.Amabile N, Fraisse A, Bouvenot J, et al. Outcome of acute fulminant myocarditis in children. Heart. 2006;92(9):1269–1273.Vashist S, Singh GK. Acute myocarditis in children: current concepts and management. Curr Treat Options Cardiovasc Med. 2009;11(5):383–391.Vashist S, Singh GK. Acute myocarditis in children: current concepts and management. Curr Treat Options Cardiovasc Med. 2009;11(5):383–391.Durani Y, Egan M, Baffa J, et al. Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med. 2009;27(8):942–947. doi: 10.1016/j.ajem.2008.07.032.Durani Y, Egan M, Baffa J, et al. Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med. 2009;27(8):942–947. doi: 10.1016/j.ajem.2008.07.032.Nakashima H, Katayama T, Ishizaki M, et al. Q wave and non-Q wave myocarditis with special reference to clinical significance. Jpn Heart J. 1998;39(6):763–774.Nakashima H, Katayama T, Ishizaki M, et al. Q wave and non-Q wave myocarditis with special reference to clinical significance. Jpn Heart J. 1998;39(6):763–774.Dasgupta S, Iannucci G, Mao C et al. Myocarditis in the pediatric population: a review. Congenit Heart Dis. 2019;14(5):868–877. doi: 10.1111/chd.12835.Dasgupta S, Iannucci G, Mao C et al. Myocarditis in the pediatric population: a review. Congenit Heart Dis. 2019;14(5):868–877. doi: 10.1111/chd.12835.Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol. 2009;53(17):1475–1487.Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol. 2009;53(17):1475–1487.Cornicelli MD, Rigsby CK, Rychlik K, et al. Diagnostic performance of cardiovascular magnetic resonance native T1 and T2 mapping in pediatric patients with acute myocarditis. J Cardiovasc Magnetic Res. 2019;21(1):40. doi: 10.1186/s12968-019-0550-7.Cornicelli MD, Rigsby CK, Rychlik K, et al. Diagnostic performance of cardiovascular magnetic resonance native T1 and T2 mapping in pediatric patients with acute myocarditis. J Cardiovasc Magnetic Res. 2019;21(1):40. doi: 10.1186/s12968-019-0550-7.Cooper LT, Baughman KL, Feldman AM, et al. The role of endomyocardial biopsy in the management of cardiovascular disease. A scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. J Am Coll Cardiol. 2007;50(19):1914–1931. doi: 10.1016/j.jacc.2007.09.008.Cooper LT, Baughman KL, Feldman AM, et al. The role of endomyocardial biopsy in the management of cardiovascular disease. A scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. J Am Coll Cardiol. 2007;50(19):1914–1931. doi: 10.1016/j.jacc.2007.09.008.Hasegawa-Tamba S, Sugi K, Gatate Y, et al. Successful bridgeto-recovery treat-mentin a young patient with fulminant eosinophilic myocarditis: roles of a percutaneous ventricular assist device and endomyocardial biopsy. Case Rep Emerg Med. 2019;2019:8236735. doi: 10.1155/2019/8236735.Hasegawa-Tamba S, Sugi K, Gatate Y, et al. Successful bridgeto-recovery treat-mentin a young patient with fulminant eosinophilic myocarditis: roles of a percutaneous ventricular assist device and endomyocardial biopsy. Case Rep Emerg Med. 2019;2019:8236735. doi: 10.1155/2019/8236735.He B, Li X, Li D. Immunosuppressive treatment for myocarditis in the pediatric population: a meta-analysis. Front Pediatr. 2019;7:430. doi: 10.3389/fped.2019.00430.He B, Li X, Li D. Immunosuppressive treatment for myocarditis in the pediatric population: a meta-analysis. Front Pediatr. 2019;7:430. doi: 10.3389/fped.2019.00430.Li Y, Yu Y, Chen S, et al. Corticosteroids and intravenous immunoglobulin in pediatric myocarditis: a meta-analysis. Front Pediatr. 2019;7:342. doi: 10.3389/fped.2019.00342.Li Y, Yu Y, Chen S, et al. Corticosteroids and intravenous immunoglobulin in pediatric myocarditis: a meta-analysis. Front Pediatr. 2019;7:342. doi: 10.3389/fped.2019.00342.

The authors declare that there are no conflicts of interest present.