Ammirati Enrico, Oliva Fabrizio, Belli Oriana, Bonacina Edgardo, Pedrotti Patrizia, Turazza Fabio Maria, Roghi Alberto, Paino Roberto, Martinelli Luigi, Frigerio Maria
'Angelo De Gasperis' Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
J Cardiovasc Med (Hagerstown). 2016 Dec;17 Suppl 2:e151-e153. doi: 10.2459/JCM.0000000000000250.
: A 31-year-old man presenting with cardiogenic shock and left ventricular ejection fraction of 10% received the diagnosis of giant cell myocarditis by endomyocardial biopsy. The patient was successfully treated with high-dose inotropes, intra-aortic balloon pump and venoarterial extracorporeal membrane oxygenation for 21 days associated with combined immunosuppression (thymoglobulin, steroids, cyclosporine). Immunosuppression including thymoglobulin is the regimen associated with the highest probability of recovery in case of giant cell myocarditis. Immunosuppression needs time to be effective; thus, hemodynamic support must be guaranteed. In the present case, we observed that full recovery can be obtained up to 21 days of support with extracorporeal membrane oxygenation and adequate immunosuppression.
一名31岁男性因心源性休克入院，左心室射血分数为10%，经心内膜心肌活检诊断为巨细胞性心肌炎。该患者接受了大剂量的正性肌力药物、主动脉内球囊反搏及静脉-动脉体外膜肺氧合治疗21天，并联合免疫抑制治疗（抗胸腺细胞球蛋白、类固醇、环孢素）。包括抗胸腺细胞球蛋白在内的免疫抑制治疗是巨细胞性心肌炎患者恢复可能性最高的治疗方案。免疫抑制需要时间才能起效，因此必须保证血流动力学支持。在本病例中，我们观察到，通过体外膜肺氧合及充分的免疫抑制治疗，在支持治疗长达21天时可实现完全恢复。
