Occurrence of Myocarditis in Sudden Death in Children

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Abstract
In recent years, there has been increasing interest in the natural history and pathophysiology of nonrheumatic inflammatory disease of the heart in children. However, because of the wide spectrum of clinical presentations and the difficulty in establishing a rapid, definitive diagnosis, the prevalence of myocarditis in any given population remains speculative. Therefore, by necessity, most studies expressing the incidence of myocarditis are derived from retrospective reviews of necropsy material. In one such review, Gore and Saphir [1] identified 1402 cases of myocarditis in 40 000 hospital necropsies for an overall prevalence of 3.5%. Seventy of these cases were associated with viral illness, and an additional 80 cases of isolated myocarditis were presumed to have been of viral etiology, therefore giving a maximal autopsy diagnosis of viral myocarditis in this group of 0.38%. In another study, Gormsen [2] identified only 17 cases of myocarditis in 1378 cases of sudden unexpected death (1.2%), but histologic examination had been carried out in only 117 of these cases. In studies of aircraft-related accidents, Stevens et al and Sopher [3,4] have postulated that the incidence of focal myocarditis in the adult population may be as high as 5%.