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Virale Myokarditis im Kindesalter

Stellenwert der modernen kardiopathologischen Diagnostik

Viral myocarditis in childhood

Impact of modern diagnostic cardiopathology

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Zusammenfassung

Die klinische Manifestation einer Myokarditis ist überaus variabel und reicht von symptomlosen Formen bis hin zum plötzlichen Herztod. Insbesondere bei Säuglingen und Kindern stellt die Diagnose einer akuten oder auch chronisch verlaufenden Herzmuskelentzündung eine große Herausforderung dar, die nur durch das konsequente Zusammenführen von klinischen, histomorphologischen, immunhistologischen und molekularpathologischen Befunden gesichert werden kann. Zum Nachweis einer infektiösen Ursache der Myokarditis stehen derzeit Untersuchungen mithilfe der Polymerase-Kettenreaktion als Screening-Verfahren sowie durch In-situ-Hybridisierung im Vordergrund der molekularpathologischen Diagnostik. Die Identifikation prognostisch gefährdeter Patienten, die zur ätiopathogenetischen Differenzierung einer Myokarditis einer Endomyokardbiopsie unterzogen werden müssen, kann neuerdings durch die Implementierung der kardialen Magnetresonanztomographie unterstützt werden. Ziel der modernen Diagnoseverfahren ist die Abschätzung der Krankheitsaktivität, um ggf. rechtzeitig eine der Ätiopathogenese entsprechende therapeutische Intervention einleiten zu können.

Abstract

The clinical course of myocarditis is highly variable and varies from subclinical infections to fulminant acute myocarditis with congestive heart failure. Especially in neonates and children the diagnosis of acute or chronic myocarditis poses a challenge which can be confirmed only by the consistent combination of clinical, histopathological, immunohistological and molecular pathological findings. For the detection of causative infectious pathogenesis in myocarditis, the polymerase chain reaction represents the appropriate screening method which is completed by in situ hybridization experiments capable of visualizing patterns of infections in the heart. The identification of patients who are at risk for a bad prognosis and have to undergo endomyocardial biopsy to achieve a differentiation of etiopathogenesis of myocarditis, can now be supported by cardiac magnetic resonance imaging. The overall aim of modern diagnostic procedures is the estimation of the stages of myocarditis that enables the clinician to provide appropriate therapy based on the etiological diagnosis of the disease.

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  1. Abteilung Molekulare Pathologie, Institut für Pathologie, Universitätsklinikum Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Deutschland

    K. Klingel & R. Kandolf

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  1. K. Klingel
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  2. R. Kandolf
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Correspondence to K. Klingel.

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Klingel, K., Kandolf, R. Virale Myokarditis im Kindesalter. Rechtsmedizin 18, 349–358 (2008). https://doi.org/10.1007/s00194-008-0543-6

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