1. Successful Bridge-to-Recovery Treatment in a Young Patient with Fulminant Eosinophilic Myocarditis: Roles of a Percutaneous Ventricular Assist Device and Endomyocardial Biopsy
- Author
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Yodo Gatate, Kanako Sugiyama, Shintaro Nakano, Saki Hasegawa-Tamba, Masanori Yasuda, Keiki Sugi, Shigeyuki Nishimura, Kenji Fukushima, and Toshihiro Muramatsu
- Subjects
medicine.medical_specialty ,Percutaneous ,Ejection fraction ,Myocarditis ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Cardiogenic shock ,Fulminant ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Case Report ,General Medicine ,lcsh:RC86-88.9 ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Ventricular assist device ,Internal medicine ,Circulatory system ,medicine ,Cardiology ,030212 general & internal medicine ,business - Abstract
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.
- Published
- 2019