Adachi Yusuke, Kinoshita Osamu, Hatano Masaru, Shintani Yukako, Naito Noritsugu, Kimura Mitsutoshi, Nawata Kan, Nitta Daisuke, Maki Hisataka, Ueda Kazutaka, Amiya Eisuke, Takimoto Eiki, Komuro Issei, Ono Minoru
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
J Med Case Rep. 2017 Oct 24;11(1):295. doi: 10.1186/s13256-017-1466-1.
Fulminant myocarditis is a life-threatening disease, and myocardial damage expands the right ventricle as well as the left ventricle in some cases. There is a mortality rate of over 40% in patients with fulminant myocarditis who need mechanical circulatory support by peripheral venoarterial extracorporeal membrane oxygenation.
We report a case of a 27-year-old Japanese woman who was successfully bridged to recovery by using a biventricular assist device. She was diagnosed with fulminant myocarditis, and peripheral venoarterial extracorporeal membrane oxygenation was established on the same day. Her left ventricular ejection fraction rapidly decreased from 40% to 5% in 3 days and weaning from venoarterial extracorporeal membrane oxygenation was deemed difficult. Therefore, we performed a ventricular assist device implantation on day 4. A left ventricular assist device was implanted first. However, adequate blood flow did not circulate to the left side of her heart because of right-sided heart failure. Thus, an additional implant of a right ventricular assist device was performed during the operation. Her left ventricular ejection fraction recovered to 50% on day 10. The biventricular assist device was successfully removed on day 14. She has not experienced worsening of biventricular function during her follow-ups for 4 years.
Ventricular assist device therapy should be considered if there is no improvement in cardiac function in patients with fulminant myocarditis regardless of several days of support by venoarterial extracorporeal membrane oxygenation. A right ventricular assist device should always be implemented when necessary because biventricular involvement is not uncommon in fulminant myocarditis.
暴发性心肌炎是一种危及生命的疾病，在某些情况下，心肌损伤会使右心室和左心室均扩大。需要通过外周静脉-动脉体外膜肺氧合进行机械循环支持的暴发性心肌炎患者死亡率超过40%。
我们报告一例27岁日本女性患者，通过使用双心室辅助装置成功过渡到康复。她被诊断为暴发性心肌炎，并于同一天建立了外周静脉-动脉体外膜肺氧合。她的左心室射血分数在3天内从40%迅速降至5%，且认为难以撤离静脉-动脉体外膜肺氧合。因此，我们在第4天进行了心室辅助装置植入。首先植入了左心室辅助装置。然而，由于右侧心力衰竭，没有足够的血流循环到她心脏的左侧。因此，在手术过程中额外植入了右心室辅助装置。她的左心室射血分数在第10天恢复到50%。双心室辅助装置在第14天成功移除。在4年的随访中，她的双心室功能没有恶化。
对于暴发性心肌炎患者，如果在接受静脉-动脉体外膜肺氧合支持数天后心脏功能没有改善，应考虑心室辅助装置治疗。由于暴发性心肌炎中双心室受累并不罕见，必要时应始终植入右心室辅助装置。
