Cardiac recovery from COVID-19-associated fulminant myocarditis by extracorporeal biventricular assist.

We report a case of cardiac recovery from coronavirus disease 2019 (COVID-19)-associated fulminant myocarditis in a 48-year-old woman diagnosed with COVID-19 infection 4 days before, whose hemodynamic collapse were resuscitated first with venoarterial extracorporeal membranous oxygenation, followed by escalation to extracorporeal biventricular assist devices (ex-BiVAD) using two centrifugal pumps and an oxygenator. She was likely to be multisystem inflammatory syndrome in adults (MIS-A) negative. Cardiac contractility gradually recovered after the 9th day of ex-BiVAD support, and the patient was successfully weaned from ex-BiVAD on the 12th day of support. Due to postresuscitation encephalopathy, she was transferred to the referral hospital for rehabilitation with recovered cardiac function. The histopathology of the myocardial tissue showed smaller amounts of lymphocytes and more infiltration of macrophages. It is important to recognize two phenotypes of MIS-A+ or MIS-A-, with distinct manifestations and outcomes. It is also important to refer urgently such patients with COVID-19-associated fulminant myocarditis, showing different histopathology from usual viral myocarditis, with evolution toward refractory cardiogenic shock to a center with capability for advanced mechanical support to avoid a too-late cannulation. Learning objective: We should recognize the clinical course and histopathology of the multisystem inflammatory syndrome in adults phenotype of coronavirus disease 2019-associated fulminant myocarditis. We should urgently refer such patients with evolution toward refractory cardiogenic shock to a center with capability for advanced mechanical support, such as venoarterial extracorporeal membrane oxygenation, Impella (Abiomed, Danvers, MA, USA), and extracorporeal biventricular assist devices.

Prophylactic use of vacuum-assisted closure system for cannula sites: A case of extracorporeal biventricular assist devices for 295 days.

We report wound management using a vacuum-assisted closure (VAC) system for the cannula sites of extracorporeal biventricular assist devices (BiVADs) for 295 days in a 23-year old Chinese female patient with fulminant giant cell myocarditis, who finally underwent heart transplantation. When the cannula sites appeared necrotic 3 months after BiVADs placement, she received negative pressure wound therapy prophylactically for four cannula sites, using a VAC system for 3 months, followed by no infections. Such prophylactic VAC therapy, using the skin barrier paste usually used for the ostomy pouching system to create a flatter surface and airtightness, may be useful to avoid cannula site infections, which is still a fatal complication causing sepsis, especially in patients with extracorporeal BiVADs.