title: Temporary mechanical support with the BVS 5000 assist device during treatment of acute myocarditis.
abstract: BACKGROUND
  Ventricular support with the BVS 5000 (Abiomed) has been used as temporary circulatory assist for the failing heart. Our purpose is to summarize four cases illustrating the role of mechanical unloading in acute myocarditis.
  
  
  METHODS
  Four patients aged 16- to 33-year old presented with congestive heart failure 4 to 20 days after a flu-like syndrome. All patients were in severe cardiogenic shock +/- renal and liver dysfunction. Ejection fraction ranged from 5% to 26%. Indications for ventricular assist were failure of maximal medical treatment with > or = two inotropes +/- intra-aortic balloon pump. Myocardial biopsy revealed acute myocarditis in three patients and severe edema in one despite a characteristic clinical course. Two patients received immunotherapy with OKT3. Biventricular assist was used in three patients and left ventricular assist only was used in one. Mean support time was 8.3 days (7 to 11).
  
  
  RESULTS
  All patients had recovery of myocardial function and were discharged from the hospital in good condition.
  
  
  CONCLUSIONS
  The BVS 5000 device provides a safe, simple, and effective method to support the circulation during acute myocarditis. We hypothesize that this may facilitate myocardial recovery by decompressing the distended ventricle. Ventricular assist devices should be used early in the presence of hemodynamic deterioration on maximal medical therapy.
authors.affiliation: UCLA Medical Center, USA.
authors.forename: D
authors.initials: D
authors.lastname: Marelli
authors.forename: H
authors.initials: H
authors.lastname: Laks
authors.forename: B
authors.initials: B
authors.lastname: Amsel
authors.forename: G K
authors.initials: GK
authors.lastname: Jett
authors.forename: G
authors.initials: G
authors.lastname: Couper
authors.forename: A
authors.initials: A
authors.lastname: Ardehali
authors.forename: A
authors.initials: A
authors.lastname: Galindo
authors.forename: D C
authors.initials: DC
authors.lastname: Drinkwater
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017548:Echocardiography, Transesophageal; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000000981:diagnostic imaging / Q000628:therapy*