Long term biventricular support with Berlin Heart Excor in a Septuagenarian with giant-cell myocarditis
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CASE REPORT
Open Access
Long term biventricular support with Berlin Heart Excor in a Septuagenarian with giant-cell myocarditis Christian Bireta1*, Theodor Tirilomis1, Marius Grossmann1, Bernhard Unsöld2, Rolf Wachter2, Thorsten Perl3, Ahmad Fawad Jebran1, Friedrich Albert Schoendube1 and Aron Frederik Popov1
Abstract Giant-cell myocarditis (GCM) is known as a rare, rapidly progressive, and frequently fatal myocardial disease in young and middle-aged adults. We report about a 76 year old male patient who underwent implantation with a biventricular Berlin Heart Excor system at the age of 74 due to acute biventricular heart failure caused by giant-cell myocarditis. The implantation was without any surgical problems; however, a difficulty was the immunosuppressive therapy after implantation. Meanwhile the patient is 76 years old and lives with circulatory support for about 3 years without major adverse events. Also, in terms of mobility in old age there are no major limitations. It seems that in even selected elderly patients an implantation of a long term support with the biventricular Berlin Heart Excor is a useful therapeutic option with an acceptable outcome.
Background Giant-cell myocarditis (GCM) is known as a rare, rapidly progressive, and frequently fatal myocardial disease in young and middle-aged adults. However, few cases have been reported on GCM in older patients. The paucity of reported cases on the elderly may reflect less frequent diagnosis or more or less fulminant course of disease in this population. Infection, autoimmune processes, and genetics have all been implicated in the pathogenesis of this disease, but the etiology is likely to be a complex multifactorial process. It is attributed to a T lymphocytemediated inflammation of the heart muscle and associates with systemic autoimmune diseases in 20% of cases [1,2]. The most common early manifestations are heart failure, ventricular arrhythmias, and atrioventricular block, but GCM may also appear as an acute myocardial infarction and rarely presents as an unexpected sudden cardiac death. Due to this unspecific clinical presentation of the patients, which may also be caused by other heart disease, the diagnosis of GCM fully depends on microscopy of the heart muscle with a sensitivity * Correspondence: [email protected] 1 Department of Thoracic and Cardiovascular Surgery, University of Goettingen, Goettingen, Robert-Koch-Strasse 40, 37075 Goettingen, Germany Full list of author information is available at the end of the article
of 80% to 85% [1,2]. The histological hallmark of GCM is a multifocal inflammatory infiltrate manifested by many multinucleated giant cells and by extensive myocardial cell necrosis in the absence of granuloma formation [3]. Because of possible life threatening complications associated with GCM and the potential for benefit from treatment, early biopsy is recommended. An early diagnosis of GCM is crucial. Also, apart from standard heart failure therapy and physical rest a tailored immunosuppressive tr
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