title: Successful treatment of near-fatal fulminant myocarditis using bi-ventricular assist device support.
abstract: Fulminant myocarditis is a rare but fatal serious disease that may cause prolonged native cardiac dysfunction with multiorgan failure despite temporary mechanical circulatory support with percutaneous venoatrial extracorporeal membrane oxygenation (VA-ECMO) or intraaortic balloon pumping (IABP). A 26-year-old man with fulminant myocarditis developed life-threatening multiorgan failure after 8 days support by VA-ECMO and IABP. He was transferred to our institution with prolonged cardiac dysfunction on hospital day 8; massive pulmonary edema developed into severe pulmonary dysfunction. Immediately after admission, VA-ECMO and IABP were switched to a paracorporeal pneumatic left ventricular assist device (LVAD) and right centrifugal ventricular assist device with an ECMO circuit shunting from the right ventricle to the pulmonary artery (RVAD-ECMO). After intensive care focusing on respiratory dysfunction, ECMO was successfully weaned, and the right ventricular assist device was switched to a durable paracorporeal pneumatic right ventricular assist device. The paracorporeal bi-ventricular assist devices were finally replaced with an implantable non-pulsatile LVAD on hospital day 181. Currently, 1 year after discharge, the patient is at home awaiting heart transplantation. Combined LVAD and RVAD-ECMO appear to be useful for resolving severe pulmonary edema due to unnecessarily long VA-ECMO support as well as kidney or liver dysfunction caused by circulatory collapse.
authors.affiliation: Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Seiko
authors.initials: S
authors.lastname: Nakajima
authors.affiliation: Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan. oseguchi@hsp.ncvc.go.jp.
authors.forename: Osamu
authors.initials: O
authors.lastname: Seguchi
authors.affiliation: Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hata
authors.affiliation: Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Kizuku
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Sunami
authors.affiliation: Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yanase
authors.affiliation: Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Norihide
authors.initials: N
authors.lastname: Fukushima
authors.affiliation: Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.affiliation: Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000503:physiopathology / Q000601:surgery*; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Extracorporeal membrane oxygenation; Fulminant myocarditis; Multiorgan failure; Ventricular assist device