Successful use of extracorporeal membrane oxygenation and drotrecogin alpha in patients with acute life-threatening myocarditis.
Acute fulminant myocarditis may present with cardiogenic shock refractory to inotropics and intra-aortic balloon pumping (IABP). Benefit of extracorporeal membrane oxygenation (ECMO) support has been established. The effectiveness of combination with ECMO or IABP and activated protein C (drotrecogin alpha; Xigris) in treatment has yet to be defined. Four patients presented with congestive heart failure 3-4 days after flu-like symptoms. Chest roentgenograms showed cardiomegaly and bilateral pulmonary infiltrates. Two-dimensional echocardiograms demonstrated severe myocardial dysfunction with left ventricular ejection fraction (LVEF), measured between 18.4% to 27% (mean, 19.5%). Three patients having been treated with the combination of ECMO or IABP and activated protein C were weaned. Follow-up LVEF measured were 39.9%, 43%, 53%, and 55%, respectively. However, 1 patient died a month later because of systemic lupus erythematosus and repeated infection. There were no neurologic sequelae in the 3 survivors. Serological test and myocardial biopsy for Parvovirus B19 was positive in 3 of 4 patients. Use of circulatory support and activated protein C is an effective alternative for acute life-threatening myocarditis.
Yu
Jung-Min
JM
Department of Cardiovascular Surgery, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung City, Taiwan.
Wu
Yi-Liang
YL
Tsao
Shih-Ming
SM
Ueng
Kwo-Chang
KC
Chen
Kuo-Shuen
KS
Wong
Hon-Phin
HP
Ying-Che
Huang
Shoo-Chay
SC
Lin
Hsiao-Wen
HW
Tsai
Tsung-Po
TP
D000328:Adult; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D017809:Fatal Outcome; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006321:Heart / Q000821:virology; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D010322:Parvoviridae Infections / Q000150:complications; D016732:Parvovirus B19, Human; D011486:Protein C / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated