Successful bridge to recovery in fulminant myocarditis using a biventricular assist device: a case report
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CASE REPORT
Open Access
Successful bridge to recovery in fulminant myocarditis using a biventricular assist device: a case report Yusuke Adachi1, Osamu Kinoshita2, Masaru Hatano1,3, Yukako Shintani4, Noritsugu Naito2, Mitsutoshi Kimura2, Kan Nawata2, Daisuke Nitta1, Hisataka Maki1, Kazutaka Ueda1,5, Eisuke Amiya1, Eiki Takimoto1,6, Issei Komuro1 and Minoru Ono2*
Abstract Background: Fulminant myocarditis is a life-threatening disease, and myocardial damage expands the right ventricle as well as the left ventricle in some cases. There is a mortality rate of over 40% in patients with fulminant myocarditis who need mechanical circulatory support by peripheral venoarterial extracorporeal membrane oxygenation. Case presentation: We report a case of a 27-year-old Japanese woman who was successfully bridged to recovery by using a biventricular assist device. She was diagnosed with fulminant myocarditis, and peripheral venoarterial extracorporeal membrane oxygenation was established on the same day. Her left ventricular ejection fraction rapidly decreased from 40% to 5% in 3 days and weaning from venoarterial extracorporeal membrane oxygenation was deemed difficult. Therefore, we performed a ventricular assist device implantation on day 4. A left ventricular assist device was implanted first. However, adequate blood flow did not circulate to the left side of her heart because of right-sided heart failure. Thus, an additional implant of a right ventricular assist device was performed during the operation. Her left ventricular ejection fraction recovered to 50% on day 10. The biventricular assist device was successfully removed on day 14. She has not experienced worsening of biventricular function during her follow-ups for 4 years. Conclusions: Ventricular assist device therapy should be considered if there is no improvement in cardiac function in patients with fulminant myocarditis regardless of several days of support by venoarterial extracorporeal membrane oxygenation. A right ventricular assist device should always be implemented when necessary because biventricular involvement is not uncommon in fulminant myocarditis. Keywords: Peripheral venoarterial extracorporeal membrane oxygenation, Fulminant myocarditis, Ventricular assist device, Biventricular assist device, Right heart failure, Case report
Background Fulminant myocarditis is often life-threatening because it may progress to cardiogenic shock. Peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is indicated for low output syndrome or life-threatening arrhythmia caused by fulminant myocarditis. A national survey in Japan showed that the mortality of patients with fulminant myocarditis who needed VA-ECMO was over * Correspondence: [email protected] 2 Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan Full list of author information is available at the end of the article
40% [1]. VA-ECMO is a life-saving device and should be immediately considered in the cas
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