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Anesthesia and Sudden Onset Cardiomyopathies in Children

  • Pediatric Anesthesia (J Lerman, Section Editor)
  • Published:
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Abstract

Purpose of Review

Anesthesiologists are often asked to provide anesthesia or sedation for previously healthy children with newly diagnosed cardiomyopathies. A thorough understanding of the disease process, diagnostic work up, and potential complications is important for safe anesthetic management. This article discusses the different classification systems, diagnostic tests, recent outcomes, and specific anesthetic considerations for children with sudden onset cardiomyopathies.

Recent Findings

New genetic and molecular research has triggered various changes in the classification system for cardiomyopathies with implications for the communication among specialties. Outcome studies have demonstrated better survival rates for the myocarditis subtype, but the frequent need for temporary extracorporeal support (ECMO).

Summary

The anesthetic management of patients with sudden onset cardiomyopathies requires full understanding of the pathophysiology and clinical status of the patient, good communication with the care team, and adequate preparation of the anesthesia location, often involving ECMO back up.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Ing RJ, Ames WA, Chambers NA. Paediatric cardiomyopathy and anaesthesia. Br J Anaesth. 2012;108(1):4–12. doi:10.1093/bja/aer408.

    Article  CAS  PubMed  Google Scholar 

  2. Rosenthal DN, Hammer GB. Cardiomyopathy and heart failure in children: anesthetic implications. Paediatr Anaesth. 2011;21(5):577–84. doi:10.1111/j.1460-9592.2011.03561.x.

    Article  PubMed  Google Scholar 

  3. Williams GD, Hammer GB. Cardiomyopathy in childhood. Curr Opin Anaesthesiol. 2011;24(3):289–300. doi:10.1097/ACO.0b013e3283462257.

    Article  PubMed  Google Scholar 

  4. Richardson P, McKenna W, Bristow M, Maisch B, Mautner B, O'Connell J, 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(5):841–2.

    Article  CAS  PubMed  Google Scholar 

  5. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation committee; Quality of Care and Outcomes Research and functional genomics and translational biology interdisciplinary working groups; and council on epidemiology and prevention. Circulation. 2006;113(14):1807–16. doi:10.1161/CIRCULATIONAHA.106.174287.

    Article  PubMed  Google Scholar 

  6. Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, et al. Classification of the cardiomyopathies: a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2008;29(2):270–6. doi:10.1093/eurheartj/ehm342.

    Article  PubMed  Google Scholar 

  7. • Konta L, Franklin RC, Kaski JP. Nomenclature and systems of classification for cardiomyopathy in children. Cardiol Young. 2015;25(Suppl 2):31–42. doi:10.1017/S1047951115001201. Review article summarizing the recent changes in nomenclature and classifcation of pediatric cardiomyopathies and its implication for future research and clinical care.

    Article  PubMed  Google Scholar 

  8. Ghelani SJ, Spaeder MC, Pastor W, Spurney CF, Klugman D. Demographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006 to 2011. Circ Cardiovasc Qual Outcomes. 2012;5(5):622–7. doi:10.1161/CIRCOUTCOMES.112.965749.

    Article  PubMed  Google Scholar 

  9. Blauwet LA, Cooper LT. Myocarditis. Prog Cardiovasc Dis. 2010;52(4):274–88. doi:10.1016/j.pcad.2009.11.006.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kuhl U, Schultheiss HP. Myocarditis in children. Heart Fail Clin. 2010;6(4):483–96. viii-ix doi:10.1016/j.hfc.2010.05.009.

    Article  PubMed  Google Scholar 

  11. Durani Y, Egan M, Baffa J, Selbst SM, Nager AL. Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med. 2009;27(8):942–7. doi:10.1016/j.ajem.2008.07.032.

    Article  PubMed  Google Scholar 

  12. • Miyake CY, Teele SA, Chen L, Motonaga KS, Dubin AM, Balasubramanian S, et al. In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. Am J Cardiol. 2014;113(3):535–40. doi:10.1016/j.amjcard.2013.10.021. Retrospective 2-center review of pediatric patients with acute myocarditis, investigating the incidence of arrhythmias and outcomes. Arryhtmias accured in 45% of patients and were associated with worse outcomes.

    Article  PubMed  Google Scholar 

  13. Mahfoud F, Gartner B, Kindermann M, Ukena C, Gadomski K, Klingel K, et al. Virus serology in patients with suspected myocarditis: utility or futility? Eur Heart J. 2011;32(7):897–903. doi:10.1093/eurheartj/ehq493.

    Article  CAS  PubMed  Google Scholar 

  14. • den Boer SL, Meijer RP, van Iperen GG, Ten Harkel AD, du Marchie Sarvaas GJ, Straver B, et al. Evaluation of the diagnostic work-up in children with myocarditis and idiopathic dilated cardiomyopathy. Pediatr Cardiol. 2015;36(2):409–16. doi:10.1007/s00246-014-1022-3. Retrospective multicenter study, evaluating the diagnostic approach and interpretation of test results in children with myocarditis and idiopathic dilated cardiomyopathy. This study showed that 23% of patients were misclassified and the authors recommend the use of a uniform step by step diagnostic protocol.

    Article  Google Scholar 

  15. Aretz HT. Myocarditis: the Dallas criteria. Hum Pathol. 1987;18(6):619–24.

    Article  CAS  PubMed  Google Scholar 

  16. Pophal SG, Sigfusson G, Booth KL, Bacanu SA, Webber SA, Ettedgui JA, et al. Complications of endomyocardial biopsy in children. J Am Coll Cardiol. 1999;34(7):2105–10.

    Article  CAS  PubMed  Google Scholar 

  17. Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT, et al. Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol. 2009;53(17):1475–87. doi:10.1016/j.jacc.2009.02.007.

    Article  PubMed  PubMed Central  Google Scholar 

  18. • Sachdeva S, Song X, Dham N, Heath DM, DeBiasi RL. Analysis of clinical parameters and cardiac magnetic resonance imaging as predictors of outcome in pediatric myocarditis. Am J Cardiol. 2015;115(4):499–504. doi:10.1016/j.amjcard.2014.11.029. Retrospective cohort study to determine predictors of early or late poor outcomes (ECMO, VAD, transplant or death) in pediatric patients with myocarditis. The authors found that an EF < 30%, peak BNP > 10000 ng/L and late enhancement on cardiac MRI were associated with poor outcomes.

    Article  PubMed  Google Scholar 

  19. Hsu DT, Canter CE. Dilated cardiomyopathy and heart failure in children. Heart Fail Clin. 2010;6(4):415–32. vii doi:10.1016/j.hfc.2010.05.003.

    Article  PubMed  Google Scholar 

  20. Levine MC, Klugman D, Teach SJ. Update on myocarditis in children. Curr Opin Pediatr. 2010;22(3):278–83. doi:10.1097/MOP.0b013e32833924d2.

    Article  PubMed  Google Scholar 

  21. Robinson J HL, Vandermeer B, Klassen TP. Intravenous immunoglobulin for presumed viralmyocarditis in children and adults. Cochrane Database Syst Rev. 2015. 2015(5). doi:10.1002/14651858.CD004370.pub3.

  22. Chen HS W, Wu SN, Liu JP. Corticosteroids for viral myocarditis. Cochrane Database Syst Rev. 2013. 2013(10). doi:10.1002/14651858.CD004471.

  23. Zafar F, Castleberry C, Khan MS, Mehta V, Bryant 3rd R, Lorts A, et al. Pediatric heart transplant waiting list mortality in the era of ventricular assist devices. J Heart Lung Transplant. 2015;34(1):82–8. doi:10.1016/j.healun.2014.09.018.

    Article  PubMed  Google Scholar 

  24. Thrush PT, Hoffman TM. Pediatric heart transplantation-indications and outcomes in the current era. J Thorac Dis. 2014;6(8):1080–96. doi:10.3978/j.issn.2072-1439.2014.06.16.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Dipchand AI, Edwards LB, Kucheryavaya AY, Benden C, Dobbels F, Levvey BJ, et al. The registry of the International Society for Heart and Lung Transplantation: Seventeenth official pediatric heart transplantation report—2014; focus theme: Retransplantation. J Heart Lung Transplant. 2014;33(10):985–95. doi:10.1016/j.healun.2014.08.002.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Annette Y. Schure

  2. Harvard Medical School, Boston, MA, USA

    Annette Y. Schure

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  1. Annette Y. Schure
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Correspondence to Annette Y. Schure.

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Annette Y. Schure declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Pediatric Anesthesia

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Schure, A.Y. Anesthesia and Sudden Onset Cardiomyopathies in Children. Curr Anesthesiol Rep 7, 135–141 (2017). https://doi.org/10.1007/s40140-017-0208-7

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  • DOI: https://doi.org/10.1007/s40140-017-0208-7

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