MANAGEMENT OF ACUTE FULMINANT MYOCARDITIS USING CIRCULATORY SUPPORT SYSTEMS

Although the natural history of acute myocarditis leads to complete re covery in the majority of patients, rapid and irreversible cardiac dec ompensation resulting in death is known to occur. One possible therapy to improve the poor prognosis of this patient group may be the implan tation of circulatory support systems that allow myocardial recovery o r bridging to heart transplantation. Therapeutic protocols have been s uggested, but clinical experiences in this area are few. In this paper we report on our clinical experiences in cardiogenic shock after acut e fulminant myocarditis using different types of circulatory support s ystems. Three different systems were used: a biomedicus centrifugal pu mp as a ventricular assist device (VAD) or femoro-femoral bypass (FFB) including oxygenator; Abiomed BVS 5000, and Thoratec ventricular assi st device. Hemodynamic criteria for implantation of support systems we re cardiac index < 2.0 L/min/m(2). SVR=1000 dyne-s-cm(-5), central ven ous pressure (CVP) or left atrial pressure (LAP) >20 mm Hg, and urine output < 20 ml/h despite maximal pharmacological therapy. Age total of 5 patients (mean age 29 years, range 15-55 years) in cardiogenic shoc k after acute fulminant myocarditis were included. Two patients initia lly were supported for stabilization and transportation from an outsid e hospital by FFB. Both patients died after a support time of 24 h bec ause of multiorgan failure or neurological disorders after longer peri ods of resuscitation in the referral hospital. The third patient (55 y ears) received the Biomedicus pump as CVAD. Myocardial function recove red after a support time of 120 h, and the patient could be weaned. Un fortunately, 2 days after weaning, he developed malignant arrhythmias and died. The 2 remaining patients (15 years and 27 years) with diagno sis of acute fulminant virus myocarditis were supported by biventricul ar assist device (1 x Thoratec/111 days, 1 x Abiomed/7 days). During t he entire time of support, there were no signs of myocardial recovery. The patients were accepted for the heart transplantation (HTX) progra m. In both cases, HTXs were performed without any complication. The po stoperative course was uneventful. The results of mechanical circulato ry support in patients with acute fulminant myocarditis are encouragin g and justify the resources.