Successive circulatory support stages: a triple bridge to recovery from fulminant myocarditis.
Fulminant myocarditis with rapid onset of symptoms and hemodynamic compromise is a rare indication for mechanical support. Because of the potentially reversible nature of this illness, advanced mechanical circulatory support is warranted to achieve recovery or as a bridge to transplantation. Circulatory device options currently available allow for a phased implementation of support modalities in a manner that reduces costs and patient risk. We present a patient with fulminant myocarditis where extracorporeal membrane oxygenation (ECMO) support escalated to short-term Levitronix CentriMag (Levitronix, Waltham, MA) biventricular assist devices (BiVADs). These in turn were exchanged, without major surgery, to long-term paracorporeal VADs (Thoratec, Pleasanton, CA). After rehabilitation and nearly total recovery, the patient was weaned from mechanical circulatory support after 104 cumulative days.
Jaroszewski
Dawn E
DE
Department of Surgery, Division Cardiothoracic Surgery, Mayo Clinic Arizona, Scottsdale, Arizona 85054, USA. Jaroszewski.dawn@mayo.edu
Marranca
Michael C
MC
Pierce
Christopher N
CN
Wong
Raymond K
RK
Steidley
Eric D
ED
Scott
Robert L
RL
Devaleria
Patrick A
PA
Arabia
Francisco
F
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D009320:Atrial Natriuretic Factor / Q000097:blood; D001777:Blood Coagulation; D016887:Cardiopulmonary Resuscitation; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006323:Heart Arrest; D006353:Heart-Assist Devices; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D009205:Myocarditis / Q000503:physiopathology / Q000601:surgery*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012770:Shock, Cardiogenic / Q000503:physiopathology / Q000601:surgery*; D013318:Stroke Volume; D016896:Treatment Outcome
D000925:Anticoagulants; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor; D006493:Heparin