Fulminant myocarditis in adults and children: bi-ventricular assist device for recovery.
OBJECTIVE
Fulminant myocarditis (FM) is uncommon and may be followed by a rapidly intractable cardiogenic shock. We report five consecutive patients with FM successfully bridged to recovery with a mechanical paracorporel biventricular assist device (BiVAD).


METHODS
Five patients, four adults and one child (mean age 27+/-6 years, range, 5-36 years) underwent implantation from November 1999 to May 2003, for FM. Prior to implantation, all patients required maximal inotropic support, three of them had an intra-aortic balloon pump, the child had an extra-corporel membrane oxygenation (ECMO) support previously inserted in another institution. Cardiac catheterisation showed a mean CPW of 37+/-1 mmHg, mean CVP 18+/-2 mmHg, and mean CI 1.7+/-0.1l/min. Echocardiogram showed a severe biventricular hypokinesia, without any ventricular dilatation and a mean LVEF at 12.5%. Two patients were implanted in cardiac arrest under external cardiac resuscitation. All patients underwent BiVAD implantation (MEDOS HIA-VAD). A 72 ml right paracorporel ventricle (a 23 ml in the child) was instituted between the double stage venous canula used during CPB and a pulmonary artery outflow canula. A 80 ml left paracorporel ventricle (a 25 ml in the child) was instituted between a left ventricle apical canula and an aorta outflow canula.


RESULTS
There was no death. The mean duration support time was 11+/-6 days (from 7 to 21 days). Two patients experienced transitory deficiency due to a stroke. Four patients showed signs of FM on histological findings. Despite serologic examination and viral genome research on myocardial biopsies, pathogenic agents were not identified. At mean follow-up of 31+/-15 months, all the patients fully recovered with a mean LVEF=60% and no left ventricular dilatation.


CONCLUSIONS
In FM with intractable cardiogenic shock, the use of a BiVAD as a bridge to recovery is a life saving approach and should be considered before multi-end organ failure.
Grinda
Jean-Michel
JM
Cardiac Surgery Department, Hôpital Europeen Georges Pompidou, 21 rue Leblanc 75908 Paris cedex 15, France. jean-michel.grinda@egp.ap-hop-paris.fr
Chevalier
Patrick
P
D'Attellis
Nicola
N
Bricourt
Marie-Odile
MO
Berrebi
Alain
A
Guibourt
Pierre
P
Fabiani
Jean-Noël
JN
Deloche
Alain
A
D000328:Adult; D002675:Child, Preschool; D004867:Equipment Design; D005112:Extracorporeal Circulation / Q000379:methods; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods; D008297:Male; D009205:Myocarditis / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012770:Shock, Cardiogenic / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology