A Case of Severe Left Heart Failure Due to Neonatal Myocarditis Successfully Treated by Balloon Atrial Septostomy

Abstract

Neonatal myocarditis is a life-threatening condition with a poor prognosis,and may require extracorporeal membrane oxygenation( ECMO) for “rescue" therapy.We report successful balloon atrial septostomy( BAS),as an alternative therapy to ECMO,in a neonate with severe left ventricular dysfunction due to coxsackie B4 viral myocarditis.In this neonate,progressive deterioration of left heart failure with pulmonary edema and severe mitral regurgitation could not be controlled with medical therapy alone.The patient was judged to require ECMO support and transferred to our hospital.However,the parents disagreed the ECMO support.Because an echocardiogram showed that his ductus arteriosus was sufficiently patent to supply systemic blood flow,we performed BAS for “rescue" therapy on day 16 of life.Immediately after BAS,an echocardiogram showed that the left atrium was decompressed safely and systemic blood flow via ductus arteriosus increased adequately.Sequential echocardiograms showed gradual improvement of left ventricular function and mitral regurgitation following preload reduction of the left ventricle.His respiratory performance and hemodynamics improved dramatically.He was discharged without any significant sequelae at two months of age.Successful therapy with a combination of ECMO and BAS has been previously reported in a patient with severe left heart failure due to acute myocarditis.However,there have been no reports of successful therapy using BAS alone in patients with acute myocarditis.BAS may be a reasonable alternative therapy to ECMO for severe heart failure due to myocarditis under conditions of sufficient patent ductus arteriosus.