Levitronix bilateral ventricular assist device, a bridge to recovery in a patient with acute fulminant myocarditis and concomitant cerebellar infarction

Abstract

We report on the case of a 27-year-old male who presented to our emergency room with chest tightness, dyspnoea and cold sweats. The 12-lead electrocardiogram showed diffuse ventricular tachycardia with wide QRS complexes. Troponin-I level was elevated to 100 ng/ml. The coronary angiogram showed good patency of all three coronary vessels, and acute fulminant myocarditis was suspected. The patient underwent cardiopulmonary resuscitation in the catheter room and high-dose inotropic support was initiated to stabilise his haemodynamic status. After resuscitation, the patient was in a coma and acute stroke was highly suspected. In addition, deteriorating cardiogenic shock with acute renal failure and pulmonary oedema were also detected. Due to haemodynamic compromise despite high-dose inotropic support, a Levitronix bilateral ventricular assist device (Bi-VAD) was implanted on an emergency basis for circulatory support. Postoperative brain computed tomography revealed acute left cerebellar infarction. Because the patient had left cerebellar infarction with right hemiplegia, heart transplantation was contraindicated. Eventually, cardiac systolic function recovered well and the patient underwent successful Bi-VAD removal after a total of 18 days on Levitronix haemodynamic support. He was weaned from the ventilator two weeks later and was discharged 10 days later.

Mechanical Circulatory Support Systems in Fulminant Myocarditis: Recent Advances and Outlook

“…However, ineligibility for the procedure or a shortage of donor organs may require an alternative, i.e., long-term MCS systems. In many reports, VAD systems were used as a bridge to recovery or transplantation, and patients with persistent biventricular failure were successfully treated with Bi-VADs [ 19 , 27 , 70 , 71 ]. It is recommended to consider early examinations for transplant and VAD evaluation to avoid subsequent delay in case of unsuccessful weaning.…”

“…In most of the reported cases, a left ventricular assist device (LVAD) was utilised and served as a bridge to transplant, recovery, or destination therapy. However, selected patients might require a bilateral ventricular assist device (Bi-VAD) [ 70 ]. Jaroszewski et al even reported a patient with FM who underwent ECMO and was bridged to temporary Bi-VAD, followed by permanent VAD systems, and eventually, recovery [ 71 ].…”