Neonatal rubella myocarditis.

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Abstract
Of 47 infants with the congenital rubella syndrome, 10 had electrocardio-graphic evidence compatible with myocardial death, injury, and ischemia. Changes were present at birth or appeared within the first 10 days of life. Seven infants had active myocardial disease in the neonatal period and 4 died. The post-mortem observations of myocardial necrosis were compatible with myocarditis of viral etiology. Three infants survived; serial electrocardiograms of these infants showed evolutionary changes similar to those observed in adults who have had myocardial infarction with subsequent healing. Three additional infants had electrocardiographic changes at birth, compatible with healed infarction, suggesting that active myocarditis had occurred with healing in utero. From these observations it can be concluded that damage to the heart and great vessels caused by the rubella virus is confined not only to the first trimester of pregnancy with production of congenital anomalies, but also that the virus may persist in the myocardium for varying periods of time after birth, producing active destruction of tissue.