title: Biventricular support using a centrifugal pump in a 6 year old with fulminant myocarditis.
abstract: We experienced a case of ventricular assist with both a pulsatile-flow and a continuous-flow pump in a pediatric patient, and herein report the clinical course and characteristics of the pumps. A 6-year-old female was diagnosed with fulminant myocarditis and transferred to our hospital for mechanical support. After 12 days of extracorporeal membrane oxygenation, we implanted a left ventricular assist device (LVAD) and a right ventricular assist device (RVAD) using centrifugal Gyro pumps with a membrane oxygenator in a paracorporeal fashion. The membrane oxygenator was removed on postoperative day (POD) 4, and the patient was weaned from the respirator on POD 6. The LVAD was exchanged on POD 13 and 17, and the RVAD was exchanged on POD 14 because of thrombus formation inside the pumps. The RVAD was removed on POD 25. On POD 32, the patient experienced cerebral infarction and the centrifugal Gyro pump was switched to an extracorporeal pulsatile pump. No thromboembolic event occurred after pump conversion, although continuous administration of vasodilators was required to avoid hypertension. She underwent successfully heart transplantation in the USA after 8 months of ventricular support. A centrifugal pump is considered useful for pediatric patients, as pump flow and blood pressure can be relatively easily controlled in the postoperative acute phase compared with the pulsatile pump. However, special care should be taken to monitor for thrombus formation when support length becomes longer than 13 days, and a switch to a pulsatile pump should be considered once the hemodynamic status stabilizes.
authors.affiliation: The Department of Cardiovascular Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandori, Suwa, Nagano, 392-8510, Japan. hiromu@shinshu-u.ac.jp.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kehara
authors.affiliation: The Department of Cardiovascular Surgery, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano, Nagano, 380-8582, Japan. ttakano-ths@umin.ac.jp.
authors.forename: Tamaki
authors.initials: T
authors.lastname: Takano
authors.affiliation: The Department of Cardiovascular Surgery, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano, Nagano, 380-8582, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Terasaki
authors.affiliation: The Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Okada
mesh_terms: D002648:Child; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D009205:Myocarditis / Q000628:therapy*; D010107:Oxygenators, Membrane; D011673:Pulsatile Flow
keywords: Biventricular assist device; Centrifugal pump; Fulminant myocarditis; Heart transplantation; Pediatric