Fulminant myocarditis treated with percutaneous cardiopulmonary support system (PCPS)

PURPOSE: Fulminant myocarditis is characterized by rapid and extensive hemodynamic compromise occurring in a previously healthy patient. The patients sometimes require mechanical circulatory support to maintain systemic perfusion. The purpose of this study was to analyze the clinical course of patients with fulminant myocarditis treated with a percutaneous cardiopulmonary support system (PCPS). PATIENTS AND METHODS: From January 1998 to November 2006, four fulminant myocarditis patients were admitted to the intensive care unit (ICU) in Gunma University Hospital and treated with PCPS to support deteriorating hemodynamics. The mean age of the 4 was 38 +/- 18 (range 14 to 57) years. None of the patients had a past history of heart disease, and the diagnosis of fulminant myocarditis was made with clinical findings and endomyocardial biopsy. Three patients were successfully removed from PCPS; one was not removed and died from cerebral bleeding. Changes in clinical findings, APACHE II scores, and laboratory data were analyzed in the 3 survivors and 1 nonsurvivor. RESULTS: Intra-aortic balloon pumping (IABP) was used in all 4 patients. The duration of PCPS support was 141, 228, and 266 h in the survivors and 330 h in the nonsurvivors. The interval between the occurrence of clinical symptoms such as fever and general fatigue and the induction of PCPS in the nonsurvivor was shorter (2 days) than in the survivors (4-6 days). Cardiac troponin I (cTnI) and creatine phosphokinase (CPK)-MB levels were significantly higher in the nonsurvivor compared with those in the survivors. Left ventricular ejection fraction (LVEF) gradually improved, and PCPS flow was decreased at around 120 h after PCPS start in the survivors; however, these improvements did not occur in the nonsurvivor. CONCLUSION: PCPS was induced in 4 fulminant myocarditis patients and successfully removed from 3 after long-term PCPS (>5 days). The maintenance of hemodynamics, especially in the acute phase of fulminant myocarditis, is important because the possibility of circulatory recovery is relatively high compared with those having severe cardiac failure resulting from other causes. The prognosis might be poor if the interval between the occurrence of clinical symptoms and PCPS deployment is short.