Successful Bridge-to-Recovery Treatment in a Young Patient with Fulminant Eosinophilic Myocarditis: Roles of a Percutaneous Ventricular Assist Device and Endomyocardial Biopsy.
Saki Hasegawa-TambaKeiki SugiYodo GatateKanako SugiyamaToshihiro MuramatsuShigeyuki NishimuraMasanori YasudaKenji FukushimaShintaro NakanoPublished in: Case reports in emergency medicine (2019)
Eosinophilic myocarditis (EM) is a rare condition characterized by myocardial eosinophilic infiltration due to various underlying etiologies. The patient with EM may benefit from appropriate use of mechanical circulatory support (MCS) that acts as a bridge to myocardial recovery in response to effective immunosuppressive therapy. A 16-year-old boy presented with cardiogenic shock due to fulminant myocarditis, for which a percutaneous ventricular assist device (PVAD) was immediately inserted. Based on the histological diagnosis of EM, immunosuppressive therapy was immediately commenced, leading to improvement of left-ventricular ejection fraction (27% to 47%). The PVAD was successfully removed on day 7. Cardiac magnetic resonance imaging and dual-tracer myocardial scintigraphy suggested limited extent of irreversible myocardial damage. For fulminant EM, the short-term use of PVAD, together with immunosuppressive therapy guided by an immediate histological investigation, may be an effective bridging strategy to myocardial recovery.
Keyphrases
- left ventricular
- aortic stenosis
- hypertrophic cardiomyopathy
- ejection fraction
- heart failure
- cardiac resynchronization therapy
- magnetic resonance imaging
- acute myocardial infarction
- left atrial
- mitral valve
- minimally invasive
- case report
- stem cells
- extracorporeal membrane oxygenation
- acute coronary syndrome
- coronary artery disease
- magnetic resonance
- percutaneous coronary intervention
- fine needle aspiration
- transcatheter aortic valve replacement
- chronic rhinosinusitis
- atrial fibrillation
- combination therapy