Case of Coronavirus Disease 2019 Myocarditis Managed With Biventricular Impella Support

Ruiz, Jose G.; Kandah, Fadi; Dhruva, Pooja; Ganji, Maedeh; Goswami, Rohan

doi:10.7759/cureus.13197

Cited by 10 publications

(11 citation statements)

References 4 publications

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“…Several previous case reports have shown successful results using the Impella for the treatment of severe myocarditis and cardiogenic shock, either in combination with ECMO (ECMELLA) or in combination with RV-Impella RP (BI-PELLA) as the only means of circulatory support. [10][11][12][13][14] On the contrary, some reports of patients with fulminant myocarditis who were not infected with COVID-19 have had successful outcomes with brief use of LV-Impella in patients who did not have significantly impaired RV function and did not require biventricular support. [15][16][17][18] This case is one of the first in which the Impella 5.0 was used alone for SARS-CoV-2 associated myocarditis.…”

Section: Discussionmentioning

confidence: 99%

“…For treatment of circulatory failure, MCS such as ECMO, assisted ventilation, and intra‐aortic balloon pumps are options for patients who do not respond to standard therapies. Several previous case reports have shown successful results using the Impella for the treatment of severe myocarditis and cardiogenic shock, either in combination with ECMO (ECMELLA) or in combination with RV‐Impella RP (BI‐PELLA) as the only means of circulatory support 10–14 . On the contrary, some reports of patients with fulminant myocarditis who were not infected with COVID‐19 have had successful outcomes with brief use of LV‐Impella in patients who did not have significantly impaired RV function and did not require biventricular support 15–18 …”

Section: Discussionmentioning

confidence: 99%

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A case of COVID‐19‐associated fulminant myocarditis successfully treated with mechanical circulatory support

Asakura

Kuroshima

Kokita

et al. 2022

Clinical Case Reports

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A 49‐year‐old man, who had not been vaccinated against COVID‐19 visited the hospital for fever and cough, and a PCR test for COVID‐19 was positive on the Day X. Initially, there was no decrease in oxygen saturation and the patient was under observation as a mild case without medication. Five days after the onset (Day X + 5), chest pain appeared. Electrocardiogram showed widespread ST‐segment elevation, and blood tests showed high levels of troponin I. However, given that there was no stenotic lesion on coronary computed tomography, myocarditis was suspected, and he was transferred to our hospital on the Day X + 6. We started treatment with lemdesivir and dexamethasone. On the Day X + 7, the patient developed decreased left ventricular ejection fraction, hypotension, and hyperlactatemia. We decided that mechanical circulatory support was necessary and an Impella 5.0 was inserted under ventilator management. The patient was successfully weaned from the Impella 5.0 on the Day X + 17, was transferred to the general ward on the Day X + 24, continued rehabilitation, and was discharged home on the Day X + 39 with no heart failure symptoms. In this case, we performed daily bedside echocardiography and chose the Impella 5.0 instead of extra corporeal membrane oxygenation (ECMO) because there were no findings of severe pneumonia or right heart failure. The Impella 5.0 device was inserted via an axillary artery approach, given that it provides more assisted flow than the Impella CP inserted through the inguinal route. Furthermore, early rehabilitation was possible due to the lack of restriction of the lower body.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A case of COVID‐19‐associated fulminant myocarditis successfully treated with mechanical circulatory support

Asakura

Kuroshima

Kokita

et al. 2022

Clinical Case Reports

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“… 40 However, multiple case reports highlight the need for prompt identification, and management necessitates MCS with VA ECMO and biventricular Impella. 39 , 41 , 42 , 43 …”

Section: Special Considerationsmentioning

confidence: 99%

Acute Circulatory Collapse and Advanced Therapies in Patients with COVID-19 Infection

Thaker¹,

Shah²,

Kim³

et al. 2021

Methodist DeBakey Cardiovascular Journal

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In the current era of the COVID-19 pandemic, intensive care patients with COVID-19 often develop respiratory failure and acute respiratory distress syndrome. While less frequent, acute circulatory collapse, with or without respiratory failure, has its own management challenges and nuances. Early identification of acute circulatory collapse requires appropriate imaging, particularly echocardiography, and precise diagnosis of cardiogenic shock using a Swan-Ganz catheter. Escalation to mechanical circulatory support (MCS), such as an intra-aortic balloon pump, Impella, and extracorporeal membrane oxygenation, has been useful in patients with acute circulatory collapse from COVID-19. This condition is associated with high morbidity and mortality, but early recognition of appropriate candidates for specific treatment strategies and escalation to MCS might improve outcomes.

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“…Coronavirus disease 2019 (COVID- 19) is a respiratory infection that first broke out in Wuhan, China in December 2019 and rapidly spread to the entire world over the next few years [1]. Many countries have experienced a multi-wave pattern in the reported cases of COVID-19 over the last three years.…”

Section: Introductionmentioning

confidence: 99%

Severe COVID-19 Myocarditis in a Young Unvaccinated Patient

Pokhriyal¹,

Pasha²,

Devi³

et al. 2023

Cureus

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Coronavirus disease 2019 (COVID-19) myocarditis is a rare but serious complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and has been associated with high-case fatality. For a very long time, since the beginning of the pandemic, there were no definitive guidelines to diagnose and manage this condition, probably secondary to the gaps in understanding the exact pathophysiology of the disease. We present the case of a young, unvaccinated female, with no comorbidities, who had an aggressively progressive COVID-19 myocarditis that was fatal. The patient presented with exertional dyspnea of two days duration and was found to be tachycardic with a heart rate ranging between 130-150 beats per minute. A nasopharyngeal swab for SARS CoV-2 was positive and a bedside echocardiogram showed a low ejection fraction of 20%. Within hours of presenting, she experienced a rapid decompensation requiring intubation. Due to fulminant myocarditis with cardiogenic shock, the patient was planned for cardiac catheterization, Impella placement, and extracorporeal membrane oxygenation (ECMO) support. The cardiac catheterization revealed non-obstructive coronary arteries and the hemodynamics suggested biventricular failure. However, around the time of the cardiac catheterization procedure, she had two events of cardiac arrest with pulseless electrical activity and unfortunately could not be revived after the second arrest despite all resuscitative efforts.

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Case of Coronavirus Disease 2019 Myocarditis Managed With Biventricular Impella Support

Cited by 10 publications

References 4 publications

A case of COVID‐19‐associated fulminant myocarditis successfully treated with mechanical circulatory support

A case of COVID‐19‐associated fulminant myocarditis successfully treated with mechanical circulatory support

Acute Circulatory Collapse and Advanced Therapies in Patients with COVID-19 Infection

Severe COVID-19 Myocarditis in a Young Unvaccinated Patient

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