ABSTRACT
Fulminant myocarditis is known as a disastrous disease that requires intensive care with mechanical cardiopulmonary support. Percutaneous cardiopulmonary bypass (PCPS), which is referred to as extracorporeal membrane oxygenation, is usually used for fulminant myocarditis. However, in some cases, PCPS may be ineffective because of circulatory insufficiency and could be associated with various severe complications such as multiple organ failure or leg ischemia. In such cases, placement of a ventricular assist device (VAD) is required. A 46-year-old man with fever and severe fatigue was admitted to a local hospital and diagnosed as having fulminant myocarditis. Although an intra-aortic balloon pump and PCPS were introduced, cardiac function was not recovered, causing multiple organ failure and leg ischemia. Hence, he was transferred to our hospital for further mechanical support. Transesophageal echocardiography (TEE) revealed severe biventricular cardiac dysfunction, and radiography showed pulmonary edema. His total bilirubin level was 6.9 mg/dl and platelet level was 3,300/μl. Thus, we implanted a biventricular assist device (BiVAD). At 12 days after the implantation, TEE revealed improvement of cardiac function, and blood biochemical examination revealed recovery of multiple organ function. Thereafter, the patient was weaned from the BiVAD successfully. After the operation, the patient underwent a long rehabilitation. He was discharged 51 days after the operation, without any neurological or cardiac complication.
ABSTRACT
Presentamos un caso de infarto agudo al miocardio complicado con shock cardiogénico y arritmias ventriculares refractarias. El paciente requirió oxigenación por membrana extracorpórea (ECMO) antes de su traslado a un hospital con asistencia ventricular izquierda (LVAD) y programa de trasplante de corazón. El paciente tuvo una buena recuperación después de 16 días de soporte con LVAD seguido de trasplante cardiaco, lo que muestra los beneficios de la terapia multimodal en casos complejos de shock cardiogénico refractario.
A case of acute myocardial infarction complicated with cardiogenic shock and refractory ventricular arrhythmias is described. The patient required extracorporeal membrane oxygenation (ECMO) prior to transfer to a hospital with a left ventricular assist device (LVAD) and heart transplantation program. He made a good recovery after 16 days of LVAD support followed by heart transplantation, showing the benefits of multimodal therapy incomplex cases of refractory cardiogenic shock Palabras clave: Infarto agudo del miocardio, shock cardiogénico,asistencia biventricular, ECMO.