title: Successive circulatory support stages: a triple bridge to recovery from fulminant myocarditis.
abstract: 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.
authors.affiliation: Department of Surgery, Division Cardiothoracic Surgery, Mayo Clinic Arizona, Scottsdale, Arizona 85054, USA. Jaroszewski.dawn@mayo.edu
authors.forename: Dawn E
authors.initials: DE
authors.lastname: Jaroszewski
authors.forename: Michael C
authors.initials: MC
authors.lastname: Marranca
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Pierce
authors.forename: Raymond K
authors.initials: RK
authors.lastname: Wong
authors.forename: Eric D
authors.initials: ED
authors.lastname: Steidley
authors.forename: Robert L
authors.initials: RL
authors.lastname: Scott
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Devaleria
authors.forename: Francisco
authors.initials: F
authors.lastname: Arabia
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor; D006493:Heparin