Published in:
01-08-2009 | Images in Pediatric Cardiology
Echocardiographic Detection of Early Myocardial Calcification in Acute Neonatal Myocarditis Due to Coxsackie Virus Type B
Published in: Pediatric Cardiology | Issue 6/2009
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A 5-day-old term baby presented in cardiogenic shock due to Coxsackie type B myocarditis complicated by refractory atrial arrhythmias and acute hepatic and renal failure. The initial echocardiogram revealed severe ventricular dysfunction with diffuse hyperechogenic foci (Supplementary Videos 1 and 2, Fig. 1). Despite aggressive medical therapy, his hemodynamic status deteriorated, requiring mechanical circulatory support initially with extracorporeal membrane oxygenation, which was subsequently replaced with a left ventricular assist device (Berlin heart). After 35 days on the assist device, the patient underwent successful cardiac transplantation. The explanted heart had myocardial dystrophic calcification by gross examination (Fig. 2) and histology (Fig. 3).
Fig. 1
Two-dimensional echocardiogram demonstrating multiple hyperechogenic foci involving the basal interventricular septum, posterior wall, and papillary muscles (arrows), corresponding to the areas of calcification on gross pathological examination. a parasternal long axis view. b apical four chamber view
Fig. 2
The heart explant shows an open left ventricle with divided Berlin heart cannula. Note the areas of calcification involving the interventricular septum, left ventricular free wall, and posterior wall, with areas of septal endocardial fibroelastosis (arrows). AV aortic valve; IVS interventricular septum; LV, left ventricle; PV pulmonary valve
Fig. 3
Histology demonstrating widespread individual and confluent myofiber necrosis and calcifications surrounded by lymphocytic infiltrates (arrows). The adjacent viable myocytes show mild to moderate hypertrophy with nuclear enlargement
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