Short-term use of "ECMELLA" in the context of fulminant eosinophilic myocarditis with cardiogenic shock
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Short-term use of "ECMELLA" in the context of fulminant eosinophilic myocarditis with cardiogenic shock. / Bohné, Mintje; Chung, Da-Un; Tigges, Eike; van der Schalk, Hendrick; Waddell, Daniela; Schenker, Niklas; Willems, Stephan; Klingel, Karin; Kivelitz, Dietmar; Bahlmann, Edda.
in: BMC CARDIOVASC DISOR, Jahrgang 20, Nr. 1, 519, 10.12.2020.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Short-term use of "ECMELLA" in the context of fulminant eosinophilic myocarditis with cardiogenic shock
AU - Bohné, Mintje
AU - Chung, Da-Un
AU - Tigges, Eike
AU - van der Schalk, Hendrick
AU - Waddell, Daniela
AU - Schenker, Niklas
AU - Willems, Stephan
AU - Klingel, Karin
AU - Kivelitz, Dietmar
AU - Bahlmann, Edda
PY - 2020/12/10
Y1 - 2020/12/10
N2 - BACKGROUND: 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.CASE PRESENTATION: 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.CONCLUSIONS: 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.
AB - BACKGROUND: 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.CASE PRESENTATION: 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.CONCLUSIONS: 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.
KW - Adult
KW - Combined Modality Therapy
KW - Device Removal
KW - Eosinophilia/complications
KW - Extracorporeal Membrane Oxygenation
KW - Female
KW - Heart-Assist Devices
KW - Humans
KW - Myocarditis/complications
KW - Prosthesis Implantation/instrumentation
KW - Recovery of Function
KW - Shock, Cardiogenic/diagnosis
KW - Treatment Outcome
KW - Ventricular Function, Left
U2 - 10.1186/s12872-020-01808-3
DO - 10.1186/s12872-020-01808-3
M3 - SCORING: Journal article
C2 - 33302874
VL - 20
JO - BMC CARDIOVASC DISOR
JF - BMC CARDIOVASC DISOR
SN - 1471-2261
IS - 1
M1 - 519
ER -