title: [Fulminant myocarditis treated with percutaneous cardiopulmonary support and long-term complications: three case reports].
abstract: A 16-year-old female underwent percutaneous cardiopulmonary support (PCPS) for treatment-resistant ventricular tachycardia, but she could not be weaned from PCPS early without complications. A 44-year-old female underwent PCPS for low cardiac output syndrome with mainly heparin used for anticoagulation. With long-term PCPS, the activated clotting time became unstable, and she died due to fatal hemorrhagic complications in the acute stage. A 71-year-old female underwent PCPS for low cardiac output syndrome with mainly nafamostat mesilate used for anticoagulation. Despite long-term extracorporeal circulation, she was weaned from PCPS without hemorrhagic complications. However, she died of multiple organ failure and systemic cytomegalovirus infection in the chronic stage. Myocardial recovery was delayed in Cases 2 and 3, so long-term PCPS was required, which resulted in severe complications. To prevent hemorrhagic complications, nafamostat mesilate should be given and activated clotting time should be measured frequently. To prevent multiple organ failure, the appropriate initial PCPS flow should be established after the evaluation of urinary output, saturation of venous oxygen, and splanchnic circulation such as arterial ketone body ratio and gastric acid secretion.
authors.affiliation: Division of Cardiology, Saiseikai Shiga Hospital, Ohashi 4-2-1, Ritto, Shiga 520-3046.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kusaba
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Nakahara
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Matsumuro
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakamura
authors.forename: Shohei
authors.initials: S
authors.lastname: Sawada
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001550:Benzamidines; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000295:instrumentation*; D017809:Fatal Outcome; D005260:Female; D006146:Guanidines / Q000627:therapeutic use; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008991:Monitoring, Physiologic; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control; D009205:Myocarditis / Q000628:therapy*; D013997:Time Factors; D014914:Whole Blood Coagulation Time
chemical_list: D000925:Anticoagulants; D001550:Benzamidines; D006146:Guanidines; D006493:Heparin; C032855:nafamostat