Short-term use of "ECMELLA" in the context of fulminant eosinophilic myocarditis with cardiogenic shock.
Adult
Combined Modality Therapy
Device Removal
Eosinophilia
/ complications
Extracorporeal Membrane Oxygenation
Female
Heart-Assist Devices
Humans
Myocarditis
/ complications
Prosthesis Implantation
/ instrumentation
Recovery of Function
Shock, Cardiogenic
/ diagnosis
Treatment Outcome
Ventricular Function, Left
Bridge-to-recovery
ECMELLA
Eosinophilic myocarditis
Mechanical circulatory support
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
10 12 2020
10 12 2020
Historique:
received:
21
09
2020
accepted:
02
12
2020
entrez:
11
12
2020
pubmed:
12
12
2020
medline:
2
2
2021
Statut:
epublish
Résumé
Eosinophilic myocarditis (EM) is a rare form of myocarditis. Clinical presentation is various, includes cardiogenic shock and can often be fatal. Diagnosis is based on myocardial eosinophilic infiltration in endomyocardial biopsy. Mechanical circulatory support (MCS) is often required in patients suffering from severe cardiogenic shock. Among the available MCS options the "ECMELLA" concept, a combination of left ventricular venting by Impella® device and extracorporeal life support (ECLS) is possibly able to provide the necessary time frame for diagnostics and initiation of anti-inflammatory medication in patients with fulminant myocarditis. We report a case of a 38-year-old woman who was presented to us in severe cardiogenic shock, quickly requiring hemodynamic support by an Impella CP® device. Further dramatic hemodynamic deterioration accompanied by multi-organ dysfunction required escalation of MCS via ECLS as veno-arterial extracorporeal membrane oxygenation (VA-ECMO). After histopathological diagnosis of EM, our patient was put on immunosuppressive therapy with prednisolone. Recovery of both right and left ventricular function allowed explanation of VA-ECMO on day 4 and further hemodynamic improvement allowed removal of the Impella® device on day 9. The patient was discharged after 7 weeks with fully restored cardiac function and in a good neurological state. In severe cardiac shock due to fulminant EM the ECMELLA concept as bridge-to-recovery seems to be a valid option to provide the required time for diagnostics and specific therapy.
Sections du résumé
BACKGROUND
Eosinophilic myocarditis (EM) is a rare form of myocarditis. Clinical presentation is various, includes cardiogenic shock and can often be fatal. Diagnosis is based on myocardial eosinophilic infiltration in endomyocardial biopsy. Mechanical circulatory support (MCS) is often required in patients suffering from severe cardiogenic shock. Among the available MCS options the "ECMELLA" concept, a combination of left ventricular venting by Impella® device and extracorporeal life support (ECLS) is possibly able to provide the necessary time frame for diagnostics and initiation of anti-inflammatory medication in patients with fulminant myocarditis.
CASE PRESENTATION
We report a case of a 38-year-old woman who was presented to us in severe cardiogenic shock, quickly requiring hemodynamic support by an Impella CP® device. Further dramatic hemodynamic deterioration accompanied by multi-organ dysfunction required escalation of MCS via ECLS as veno-arterial extracorporeal membrane oxygenation (VA-ECMO). After histopathological diagnosis of EM, our patient was put on immunosuppressive therapy with prednisolone. Recovery of both right and left ventricular function allowed explanation of VA-ECMO on day 4 and further hemodynamic improvement allowed removal of the Impella® device on day 9. The patient was discharged after 7 weeks with fully restored cardiac function and in a good neurological state.
CONCLUSIONS
In severe cardiac shock due to fulminant EM the ECMELLA concept as bridge-to-recovery seems to be a valid option to provide the required time for diagnostics and specific therapy.
Identifiants
pubmed: 33302874
doi: 10.1186/s12872-020-01808-3
pii: 10.1186/s12872-020-01808-3
pmc: PMC7731477
doi:
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
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