Successful Bridge-to-Recovery Treatment in a Young Patient with Fulminant Eosinophilic Myocarditis: Roles of a Percutaneous Ventricular Assist Device and Endomyocardial Biopsy.

Keiki Sugi,Shigeyuki Nishimura,Kenji Fukushima,Shintaro Nakano,Toshihiro Muramatsu,Yodo Gatate,Saki Hasegawa-Tamba,Masanori Yasuda,Kanako Sugiyama

doi:10.1155/2019/8236735

Keiki Sugi, Shigeyuki Nishimura + Show 7 more

Open Access

https://doi.org/10.1155/2019/8236735

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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.

Highlights

Eosinophilic myocarditis (EM) is a rare condition characterized by myocardial eosinophilic infiltration due to various underlying etiologies [1,2,3,4]
EM manifests as fulminant myocarditis that is often fatal [5, 6], the patient may benefit from appropriate use of mechanical circulatory support (MCS) that acts as a bridge to myocardial recovery in response to effective immunosuppressive therapy
We present the case of a young boy who survived fulminant EM with successful short-term MCS using percutaneous left-ventricular (LV) assist device (PVAD)

Summary

Introduction

Eosinophilic myocarditis (EM) is a rare condition characterized by myocardial eosinophilic infiltration due to various underlying etiologies [1,2,3,4]. EM manifests as fulminant myocarditis that is often fatal [5, 6], the patient may benefit from appropriate use of mechanical circulatory support (MCS) that acts as a bridge to myocardial recovery in response to effective immunosuppressive therapy. The Impella 2.5 system (Abiomed, Danvers, MA, USA), a miniature percutaneous left-ventricular (LV) assist device (PVAD), was launched in our county in September 2017. It equips axial-flow pumps from the left ventricle to the ascending aorta to unload the left ventricle as well as provide flow support up to 2.5 L/min [8, 12]. As a bridge to myocardial recovery in response to histologyguided immunosuppressive therapy

Case Presentation

Findings

Discussion