title: Hemodynamic Transesophageal Echocardiography-Guided Venous-Arterial Extracorporeal Membrane Oxygenation Support in a Case of Giant Cell Myocarditis.
abstract: Giant cell myocarditis (GCM) is a rare and commonly fatal form of fulminant myocarditis. During the acute phase, while immunosuppressive therapy is initiated, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is commonly used as a bridge to heart transplantation or recovery. Until recently, conventional transesophageal echocardiography and transthoracic echocardiography were the tools available for hemodynamic assessment of patients on this form of mechanical circulatory support. Nevertheless, both techniques have their limitations. We present a case of a 54-year-old man diagnosed with GCM requiring VA-ECMO support that was monitored under a novel miniaturized transesophageal echocardiography (hTEE) probe recently approved for 72 hours of continuous hemodynamic monitoring. Our case highlights the value of this novel, flexible, and disposable device for hemodynamic monitoring, accurate therapy guidance, and potential VA-ECMO weaning process of patients with this form of severe myocarditis.
authors.affiliation: Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA.
authors.forename: Juan G
authors.identifier: 0000-0003-4908-9774
authors.initials: JG
authors.lastname: Ripoll
authors.affiliation: Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA; Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Ratzlaff
authors.affiliation: Department of Pathology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Menke
authors.affiliation: Department of Pathology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Olave
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic, 200 First St SW, Rochester, MN, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Maleszewski
authors.affiliation: Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA; Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA; Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA.
authors.forename: José L
authors.identifier: 0000-0002-8377-1737
authors.initials: JL
authors.lastname: Díaz-Gómez