Fulminant myocarditis in adults and children: bi-ventricular assist device for recovery
| Autor: | Alain Berrebi, Pierre Guibourt, Jean-Michel Grinda, Alain Deloche, Marie-Odile Bricourt, Jean-Noël Fabiani, P. Chevalier, Nicola D'Attellis |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Adult
Male Reoperation Pulmonary and Respiratory Medicine Extracorporeal Circulation medicine.medical_specialty Myocarditis medicine.medical_treatment Shock Cardiogenic Ventricular Function Left Postoperative Complications Internal medicine medicine.artery medicine Extracorporeal membrane oxygenation Humans Intra-Aortic Balloon Pumping Ejection fraction business.industry Cardiogenic shock Extracorporeal circulation Equipment Design General Medicine medicine.disease Treatment Outcome medicine.anatomical_structure Ventricle Child Preschool Heart failure Pulmonary artery Cardiology Female Surgery Heart-Assist Devices Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 26:1169-1173 |
| ISSN: | 1010-7940 |
| DOI: | 10.1016/j.ejcts.2004.05.059 |
| Popis: | Objective: Fulminant myocarditis (FM) is uncommon and may be followed by a rapidly intractable cardiogenic shock. We report five consecutive patients with FM successfully bridged to recovery with a mechanical paracorporel biventricular assist device (BiVAD). Methods: Five patients, four adults and one child (mean age 27C/K6 years, range, 5–36 years) underwent implantation from November 1999 to May 2003, for FM. Prior to implantation, all patients required maximal inotropic support, three of them had an intra-aortic balloon pump, the child had an extra-corporel membrane oxygenation (ECMO) support previously inserted in another institution. Cardiac catheterisation showed a mean CPW of 37C/K1 mmHg, mean CVP 18C/K2 mmHg, and mean CI 1.7C/K0.1 l/min. Echocardiogram showed a severe biventricular hypokinesia, without any ventricular dilatation and a mean LVEF at 12.5%. Two patients were implanted in cardiac arrest under external cardiac resuscitation. All patients underwent BiVAD implantation (MEDOS HIA-VAD). A 72 ml right paracorporel ventricle (a 23 ml in the child) was instituted between the double stage venous canula used during CPB and a pulmonary artery outflow canula. A 80 ml left paracorporel ventricle (a 25 ml in the child) was instituted between a left ventricle apical canula and an aorta outflow canula. Results: There was no death. The mean duration support time was 11C/K6 days (from 7 to 21 days). Two patients experienced transitory deficiency due to a stroke. Four patients showed signs of FM on histological findings. Despite serologic examination and viral genome research on myocardial biopsies, pathogenic agents were not identified. At mean follow-up of 31C/K15 months, all the patients fully recovered with a mean LVEFZ60% and no left ventricular dilatation. Conclusions: In FM with intractable cardiogenic shock, the use of a BiVAD as a bridge to recovery is a life saving approach and should be considered before multi-end organ failure. q 2004 Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|