title: Giant cell myocarditis: clinical presentation, bridge to transplantation with mechanical circulatory support, and long-term outcome.
abstract: BACKGROUND
  The multicenter Giant Cell Myocarditis Registry recorded 64 cases from 36 centers before 1996. The median transplant-free survival of 30 patients without immunosuppression was 3 months. Of 34 patients who received heart transplantations, 9 experienced recurrence of giant cell myocarditis in their transplanted hearts and 1 patient died.
  
  
  METHODS
  We reviewed our experience in 340 heart transplantations since 1984. Unexpected giant cell myocarditis was found in the explanted hearts of 7 patients (6 men and 1 female, aged 18-65 years).
  
  
  RESULTS
  The duration from the onset of symptoms to assist-device implant or transplantation ranged from 11 days to 9 years, whereas the time interval from referral or deterioration ranged from 2 days to 4 months. Four patients required mechanical circulatory support before surgery (total artificial hearts in 2 and left ventricular assist devices in 2), and 3 patients required inotropic drugs. Six patients are alive with no sign of recurrent giant cell myocarditis at 12 to 113 months after surgery. One patient died suddenly 75 months after surgery, and autopsy showed severe graft vascular disease with no recurrence of giant cell myocarditis. Surveillance, right ventricular endomyocardial biopsy specimens showed recurrent asymptomatic giant cell myocarditis in 3 patients at 5 to 13 months after surgery, and found recurrence in 1 patient 30 months after surgery. This patient received augmented immunosuppression.
  
  
  CONCLUSIONS
  Giant cell myocarditis often is not diagnosed before transplantation. It can present as dilated cardiomyopathy with late deterioration, or it can present with rapid hemodynamic deterioration. In our experience, these patients can be bridged successfully to transplant with mechanical circulatory assist. Giant cell myocarditis may recur after transplantation but may respond to augmented immunosuppression.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. radavies@ottawaheart.ca
authors.forename: Ross A
authors.initials: RA
authors.lastname: Davies
authors.forename: John P
authors.initials: JP
authors.lastname: Veinot
authors.forename: Stuart
authors.initials: S
authors.lastname: Smith
authors.forename: Christine
authors.initials: C
authors.lastname: Struthers
authors.forename: Paul
authors.initials: P
authors.lastname: Hendry
authors.forename: Roy
authors.initials: R
authors.lastname: Masters
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000473:pathology / Q000601:surgery*; D012008:Recurrence