Fulminant myocarditis in adults and children: bi-ventricular assist device for recovery

Objective: Fulminant myocarditis (FM) is uncommon and may be followed by a rapidly intractable cardiogenic shock. We report five consecutive patients with FM successfully bridged to recovery with a mechanical paracorporel biventricular assist device (BiVAD). Methods: Five patients, four adults and one child (mean age 27+/−6 years, range, 5–36 years) underwent implantation from November 1999 to May 2003, for FM. Prior to implantation, all patients required maximal inotropic support, three of them had an intra-aortic balloon pump, the child had an extra-corporel membrane oxygenation (ECMO) support previously inserted in another institution. Cardiac catheterisation showed a mean CPW of 37+/−1mmHg, mean CVP 18+/−2mmHg, and mean CI 1.7+/−0.1l/min. Echocardiogram showed a severe biventricular hypokinesia, without any ventricular dilatation and a mean LVEF at 12.5%. Two patients were implanted in cardiac arrest under external cardiac resuscitation. All patients underwent BiVAD implantation (MEDOS HIA-VAD). A 72ml right paracorporel ventricle (a 23ml in the child) was instituted between the double stage venous canula used during CPB and a pulmonary artery outflow canula. A 80ml left paracorporel ventricle (a 25ml in the child) was instituted between a left ventricle apical canula and an aorta outflow canula. Results: There was no death. The mean duration support time was 11+/−6 days (from 7 to 21 days). Two patients experienced transitory deficiency due to a stroke. Four patients showed signs of FM on histological findings. Despite serologic examination and viral genome research on myocardial biopsies, pathogenic agents were not identified. At mean follow-up of 31+/−15 months, all the patients fully recovered with a mean LVEF=60% and no left ventricular dilatation. Conclusions: In FM with intractable cardiogenic shock, the use of a BiVAD as a bridge to recovery is a life saving approach and should be considered before multi-end organ failure.