Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany.
Department of Cardiopathology, Institute for Pathology, University Hospital Tübingen, Tübingen, Germany.
BMC Cardiovasc Disord. 2020 Dec 10;20(1):519. doi: 10.1186/s12872-020-01808-3.
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.
嗜酸性心肌炎（EM）是一种罕见的心肌炎形式。临床表现多种多样，包括心源性休克，且常可致命。诊断基于心肌内嗜酸性粒细胞浸润的心肌活检。患有严重心源性休克的患者通常需要机械循环支持（MCS）。在现有的 MCS 选择中，“ECMELLA”概念，即 Impella®装置左心室引流与体外生命支持（ECLS）的结合，可能能够为暴发性心肌炎患者提供诊断和启动抗炎药物所需的时间框架。
我们报告了一例 38 岁女性患者，因严重心源性休克迅速需要 Impella CP®装置进行血流动力学支持。进一步的严重血流动力学恶化伴有多器官功能障碍，需要通过静脉-动脉体外膜肺氧合（VA-ECMO）升级 MCS。在 EM 的组织病理学诊断后，我们的患者接受了泼尼松龙免疫抑制治疗。右心室和左心室功能的恢复允许在第 4 天行 VA-ECMO 脱机，进一步的血流动力学改善允许在第 9 天行 Impella®装置移除。患者在 7 周后出院，心功能完全恢复，神经状态良好。
在由暴发性 EM 引起的严重心脏休克中，ECMELLA 概念作为恢复桥似乎是一种有效的选择，可以为诊断和特定治疗提供所需的时间。
