Fulminant myocarditis in adults and children: bi-ventricular assist device for recovery

Abstract

Objective: Fulminant myocarditis (FM) is uncommon and may be followed by a rapidly intractable cardiogenic shock. We report five consecutive patients with FM successfully bridged to recovery with a mechanical paracorporel biventricular assist device (BiVAD). Methods: Five patients, four adults and one child (mean age 27C/K6 years, range, 5-36 years) underwent implantation from November 1999 to May 2003, for FM. Prior to implantation, all patients required maximal inotropic support, three of them had an intra-aortic balloon pump, the child had an extra-corporel membrane oxygenation (ECMO) support previously inserted in another institution. Cardiac catheterisation showed a mean CPW of 37C/K1 mmHg, mean CVP 18C/K2 mmHg, and mean CI 1.7C/K0.1 l/min. Echocardiogram showed a severe biventricular hypokinesia, without any ventricular dilatation and a mean LVEF at 12.5%. Two patients were implanted in cardiac arrest under external cardiac resuscitation. All patients underwent BiVAD implantation (MEDOS HIA-VAD). A 72 ml right paracorporel ventricle (a 23 ml in the child) was instituted between the double stage venous canula used during CPB and a pulmonary artery outflow canula. A 80 ml left paracorporel ventricle (a 25 ml in the child) was instituted between a left ventricle apical canula and an aorta outflow canula. Results: There was no death. The mean duration support time was 11C/K6 days (from 7 to 21 days). Two patients experienced transitory deficiency due to a stroke. Four patients showed signs of FM on histological findings. Despite serologic examination and viral genome research on myocardial biopsies, pathogenic agents were not identified. At mean follow-up of 31C/K15 months, all the patients fully recovered with a mean LVEFZ60% and no left ventricular dilatation. Conclusions: In FM with intractable cardiogenic shock, the use of a BiVAD as a bridge to recovery is a life saving approach and should be considered before multi-end organ failure. q

Levitronix Ventricular Assist Devices as a Bridge to Recovery After Profound Biventricular Heart Failure Associated With Pulmonary Aspergillosis

“…16 In the setting of fulminant myocarditis, there may be a role for VAD support, 17 which would be different from the bridge to transplantation 18 and would function as a bridge-to-recovery. 8,15,19 In the recovery setting, most of the decision making is determining who is a good candidate.…”

Mechanical circulation support of the treatment for children with end-stage chronic heart failure

“…[56] и Grinda с соавт. [57] также подтверждают высокую вероят-ность восстановления миокарда у детей при приме-нении МПК.…”

“…8. Survival of children after heart transplantation with pre-transplantation IPC (ECMO and Left Ventricular Bypass) and without mechanical support of blood circulation xas США) [57] и HeartWareHvad (HeartWare, Framingham, MA. США), осевые насосы HeartMate II (Thoratec Corporation США), Jarvik 2000 FlowMaker (Jarvik Heart, Inc., New York, CША) [58][59][60].…”

Acute Myocarditis in Emergency Medicine

“…In such cases, the patient should be switched to a ventricular assist system (VAS) before organ dysfunction develops. Grinda et al (2004) reported that they introduced VAS in five cases of severe fulminant myocarditis and obtained good outcomes. Recently, the clinical effectiveness of modified VAS using an extracorporeally established centrifugal pump was advocated by John et al (2007) in the United States.…”