Myocarditis from Fetal to Neonates: Our Experience to Diagnosis Treatment and Outcomes in a Single Centre

Aim: We performed a retrospective analysis of 89 fetal echograms (in between 01.2015 and 10.2016).

Methods: Prenatal ultrasound screening included 2-D and 3/4-D EchoCG. Diagnosis was confirmed either by postnatal EchoCG or autopsy; the percentage of prenatal mistakes was 0%. After birth newborns underwent routine cardiology examination with EchoCG, diagnostic blood tests, virus antibody tests.

Results: 89\2586 (3.4%) CHD foetuses with a prenatal diagnosis of myocarditis were enrolled. Initial fetal EchoCGs were obtained between 12 and 39 weeks of gestation (median 24.5 weeks). Diagnostic ultrasound criteria and complications: dilatation of LV(87/89) and dilatation of RV(2/89) with poor ventricular function; AV regurgitation and pericardial effusion(89/89); fetal non-immune hydrops(21/89); fetal arrhythmias AVB, bradyarrhythmia(11/89). Outcomes for the cases with fetal myocarditis: the termination of pregnancy 9/89(10.1%); intrauterine fetal death 4/89(4.5%), neonatal death soon after birth 6/89(6.7%), fetal successful treatment 67/89(75.2%). Of 67 newborns 25(37%) were a previously successful cases of fetal myocarditis treatment; also 25(37%) cases had CHD, of which 16/25(64%) were critical CHD (CCHD). In all CHD cases myocardial antibody titre was higher than the reference value. Of virus antibody tests positive results were obtained for: CMV (20/25), HHV type 1(165), and EBV (46). Patients with CHD and myocarditis combined were indicative of heart failure (mean NYHA class 3.1): pericardial effusion (10/25), dilatation heart cavities or myocardial hypertrophy (195) with reduction systolic function. The CHD in newborns with prenatal myocardities were primarily represented by critical CHD 165 (64%). All patients underwent the following active treatment: glucocorticosteroids; NSA; anti-virus/anti-bacterial; beta blocker, heart failure and arrhythmia therapy. Neonates with CCHD required emergent surgical intervention due to CCHD incidence and other planned CHD repair. Before 1 year 3(3.3%) infants with AVB underwent pacemaker implantations. Hospital mortality was 0%.