Restrictive Atrial Septal Defect and Pulmonary Artery Banding Promote Functional Recovery in Infants and Young Children with Myocarditis and DCM Phenotype

All articles of this category (opens in new window) Background: Severe myocarditis can lead to chronic heart failure, progressing to dilated cardiomyopathy (DCM) and sometimes requiring ventricular assist device (VAD) and heart transplantation (HTx). In younger patients, myocardial recovery is possible; therefore, strategies enhancing this potential should be considered. Methods: From 2013 to 2024, 17 patients with biopsy- and/or MRI-confirmed myocarditis presenting with a DCM phenotype were included. All were initially referred for HTx evaluation. A physiology-based approach was used, including tailored medical therapy, creation/enlargement of a restrictive atrial septal defect (rASD), and pulmonary artery banding (PAB). Data on baseline characteristics, catheterization, and outcomes were analyzed. Results: Patients had a mean age of 365 days and body weight of 8 kg. Nine were female. At presentation, the mean LVEF was 19%, with markedly increased end-diastolic diameter (z-score +6). BNP was elevated (mean: 2,129 pg/mL), and heart rate averaged 126 bpm. Catheterization in 16 patients revealed a high left ventricular end-diastolic pressure (mean: 19 mm Hg). Creation of rASD or PFO dilation was performed in 10 patients. Biopsies revealed interstitial fibrosis consistent with adverse remodeling. After PAB, 13 Patients (76%) showed significant myocardial recovery, with normalization of ventricular function. Paired analysis showed significant improvements in LVEF ( p < 0.001) and LVEDd ( p < 0.001). Three patients underwent HTx; one died from rejection, and one remains listed. Ten patients had partial debanding with sustained LV function. Conclusion: Despite severe initial dysfunction and fibrosis, the comprehensive approach using rASD and PAB resulted in a 76% recovery rate, highlighting the regenerative potential in infants’ myocardium. None required VAD, and recovery was sustained after partial debanding. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany