title: Interventional and medical treatment of acute heart failure due to inflammation: four cases.
abstract: Four patients (aged 15-41 years, mean age 26.7 years) with fulminant myocarditis undergoing mechanical circulatory support are reported. All patients suffered from acute low-output syndrome refractory to inotropic support. Diagnosis was confirmed by histology and immunohistochemistry. RT-PCR (reverse transcription-polymerase chain reaction) from endomyocardial biopsy specimens revealed parvovirus B19 in two patients and a coinfection with Chlamydia pneumoniae and parvovirus B19 in one patient. Midterm support with the biventricular Thoratec system was preceded by implantation of an extracorporeal membrane oxygenation (ECMO) device in two patients. Two patients regained full cardiac function and were successfully weaned from the ventricular assist device (VAD) after 12 and 40 days. Heart transplantation was performed in another patient without evidence of myocardial recovery after 53 days. One patient died of cerebral hemorrhage on day 12 after VAD implantation. In summary, patients with life-threatening fulminant myocarditis can be successfully bridged to recovery or transplantation with mechanical circulatory support.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Innsbruck Medical University, Innsbruck, Austria. gerhard.poelzl@uklibk.ac.at
authors.forename: Gerhard
authors.initials: G
authors.lastname: Poelzl
authors.forename: Matthias
authors.initials: M
authors.lastname: Frick
authors.forename: Herwig
authors.initials: H
authors.lastname: Antretter
authors.forename: Daniel
authors.initials: D
authors.lastname: Hoefer
authors.forename: Christoph
authors.initials: C
authors.lastname: Hoermann
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schweigmann
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
authors.forename: Otmar
authors.initials: O
authors.lastname: Pachinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002303:Cardiac Output, Low / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents