{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:58:07Z","timestamp":1791406687693,"version":"4.3.3"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The incidence of parvovirus B19 (B19\u2005V)-associated myocarditis progressing to dilated cardiomyopathy (DCM) is on the rise. We hypothesize that a comprehensive treatment regimen enables cardiac regeneration in young patients with life-threatening B19\u2005V myocarditis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Four patients with clinical and imaging evidence of DCM were referred due to suspected myocarditis. An endomyocardial biopsy (EMB) confirmed the diagnosis. The diastolic dysfunction associated with heart failure and reduced left ventricular ejection fraction (HFrEF) was established invasively. Before surgical pulmonary artery banding (PAB), a transcatheter procedure was performed to create a restrictive atrial defect (rASD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The drug-treated patients (ages 15\u201326 months) had a mean LV-EF of 22.5% (20%\u201325%), a left ventricular end-diastolic diameter (LVEDD) of 49 (45\u201351)\u2005mm (Z-score &amp;gt;5), and elevated LVED pressures (&amp;gt;18\u2005mmHg). EMB revealed B19V-associated acute\/subacute or chronic active myocarditis with characteristics of DCM. Drug therapy, including immunoglobulins and creating a rASD, resulted in clinical improvement and enhanced right ventricular function. However, LV enlargement and dysfunction persisted. Four weeks after surgical PAB, all patients showed improvement and were discharged home. The pressure gradient across the PAB ranged from 40 to 45\u2005mmHg, and LVEDD decreased to a mean z-score of +3.5. Within three to six months, LVEDD normalized, and LV-EF increased to a mean of 63% (range: 57%\u201368%). Clinical and cardiac improvements were sustained over a median follow-up of 7.5 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A holistic treatment approach allows functional regeneration in B19\u2005V myocarditis with obvious end-stage DCM. Restrictive ASD creation is required before surgical PAB when HFrEF is associated with a diastolic dysfunction component.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1579212","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T05:22:09Z","timestamp":1749187329000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Full recovery in severe ParvovirusB19 myocarditis with DCM phenotype: the impact of rASD and PAB"],"prefix":"10.3389","volume":"13","author":[{"given":"T.","family":"Logeswaran","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Akint\u00fcrk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Rueblinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Gummel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Klingel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Jux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Steinbrenner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Schranz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1007\/s00246-012-0468-4","article-title":"Parvovirus B19 myocarditis causes significant morbidity and mortality in children","volume":"34","author":"Molina","year":"2013","journal-title":"Pediatr Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"34","DOI":"10.3390\/children6020034","article-title":"Status of pediatric cardiac care in developing countries","volume":"6","author":"Saxena","year":"2019","journal-title":"Children"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1592","DOI":"10.1016\/j.athoracsur.2008.07.022","article-title":"Costs associated with ventricular assist device use in children","volume":"86","author":"Mahle","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1459","DOI":"10.1016\/j.healun.2018.08.005","article-title":"Bridge to recovery in children on ventricular assist devices\u2014protocol, predictors of recovery, and long-term follow-up","volume":"37","author":"Miera","year":"2018","journal-title":"J Hear Lung Transplant"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1909","DOI":"10.3390\/biomedicines12081909","article-title":"Lymphocytic myocarditis in children with parvovirus B19 infection: pathological and molecular insights","volume":"12","author":"Pelzl","year":"2024","journal-title":"Biomedicines"},{"key":"B6","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1007\/s10741-012-9357-4","article-title":"Viral myocarditis: from experimental models to molecular diagnosis in patients","volume":"18","author":"Pankuweit","year":"2013","journal-title":"Hear Fail Rev"},{"key":"B7","doi-asserted-by":"publisher","first-page":"88","DOI":"10.7150\/ijms.8.88","article-title":"Parvovirus B19 nonstructural protein-induced damage of cellular DNA and resultant apoptosis","volume":"8","author":"Poole","year":"2011","journal-title":"Int J M\u00e9d Sci"},{"key":"B8","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1007\/s00059-004-2626-9","article-title":"Inflammation in dilated cardiomyopathy","volume":"29","author":"Pankuweit","year":"2004","journal-title":"Herz"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1002\/jmv.21187","article-title":"Prevalence of erythrovirus genotypes in the myocardium of patients with dilated cardiomyopathy","volume":"80","author":"K\u00fchl","year":"2008","journal-title":"J M\u00e9d Virol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1038\/s41569-020-00435-x","article-title":"Myocarditis and inflammatory cardiomyopathy: current evidence and future directions","volume":"18","author":"Tsch\u00f6pe","year":"2021","journal-title":"Nat Rev Cardiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2636","DOI":"10.1093\/eurheartj\/eht210","article-title":"Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology working group on myocardial and pericardial diseases","volume":"34","author":"Caforio","year":"2013","journal-title":"Eur Hear J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"133","DOI":"10.21037\/tp.2019.04.03","article-title":"Restrictive atrial communication in right and left heart failure","volume":"8","author":"Bauer","year":"2019","journal-title":"Transl Pediatr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1017\/s1047951118002433","article-title":"Transcatheter left atrial decompression in patients with dilated cardiomyopathy: bridging to cardiac transplantation or recovery","volume":"29","author":"Bauer","year":"2019","journal-title":"Cardiol Young"},{"key":"B14","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1161\/01.cir.56.3.457","article-title":"Evaluation of left ventricular size and function by echocardiography. Results in normal children","volume":"56","author":"Gutgesell","year":"2018","journal-title":"Circulation"},{"key":"B15","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1007\/s00431-016-2700-3","article-title":"Nihilism\u201d of chronic heart failure therapy in children and why effective therapy is withheld","volume":"175","author":"Schranz","year":"2016","journal-title":"Eur J Pediatr"},{"key":"B16","doi-asserted-by":"publisher","first-page":"151","DOI":"10.21037\/tp.2019.04.09","article-title":"Pulmonary artery banding in dilative cardiomyopathy of young children: review and protocol based on the current knowledge","volume":"8","author":"Schranz","year":"2019","journal-title":"Transl Pediatr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.healun.2022.07.013","article-title":"Waitlist and post-transplant outcomes for children with myocarditis listed for heart transplantation over 3 decades","volume":"42","author":"Amdani","year":"2023","journal-title":"J Hear Lung Transplant"},{"key":"B18","doi-asserted-by":"publisher","first-page":"107391","DOI":"10.1016\/j.carpath.2021.107391","article-title":"Myocardial fibrosis: morphologic patterns and role of imaging in diagnosis and prognostication","volume":"56","author":"Giordano","year":"2022","journal-title":"Cardiovasc Pathol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1017\/s1047951116000706","article-title":"Left ventricular end-diastolic dimension as a predictive factor of outcomes in children with acute myocarditis","volume":"27","author":"Kim","year":"2017","journal-title":"Cardiol Young"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.3390\/microorganisms12081708","article-title":"Parvovirus B19 in rheumatic diseases","volume":"12","author":"Arvia","year":"2024","journal-title":"Microorganisms"},{"key":"B21","doi-asserted-by":"publisher","first-page":"5240","DOI":"10.3390\/jcm10225240","article-title":"Viral myocarditis\u2014from pathophysiology to treatment","volume":"10","author":"Schultheiss","year":"2021","journal-title":"J Clin Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1016\/j.jcmg.2018.01.028","article-title":"Imaging right-left ventricular interactions","volume":"11","author":"Friedberg","year":"2018","journal-title":"JACC: Cardiovasc Imaging"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e94382","DOI":"10.1172\/jci.insight.94382","article-title":"Pediatric and adult dilated cardiomyopathy represent distinct pathological entities","volume":"2","author":"Patel","year":"2017","journal-title":"JCI Insight"},{"key":"B24","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.healun.2013.01.988","article-title":"Pulmonary artery banding in infants and young children with left ventricular dilated cardiomyopathy: a novel therapeutic strategy before heart transplantation","volume":"32","author":"Schranz","year":"2013","journal-title":"J Hear Lung Transplant"},{"key":"B25","doi-asserted-by":"publisher","first-page":"79","DOI":"10.3390\/jcdd11030079","article-title":"Prophylactic pulmonary artery banding in pediatric dilated cardiomyopathy: an additional therapeutic option","volume":"11","author":"Panaioli","year":"2024","journal-title":"J Cardiovasc Dev Dis"},{"key":"B26","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/978-981-99-2862-0_28","volume-title":"Congenital and Paediatric Acquired Heart Disease in Practice","author":"Cheung","year":"2023"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1579212\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T05:22:10Z","timestamp":1749187330000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1579212\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,6]]},"references-count":26,"alternative-id":["10.3389\/fped.2025.1579212"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1579212","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,6]]},"article-number":"1579212"}}