J Korean Med Sci.  2015 Sep;30(9):1367-1372. 10.3346/jkms.2015.30.9.1367.

Pathological Substratum for a Case of Fulminant Myocarditis Treated with Extracorporeal Membrane Oxygenation and Subsequent Heart Transplantation

Affiliations
  • 1Department of Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
  • 2Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea. yang.hyun@gmail.com
  • 3Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
  • 4Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.

Abstract

Fulminant myocarditis has been defined as the clinical manifestation of cardiac inflammation with rapid-onset heart failure and cardiogenic shock. We report on the case of a 23-yr-old woman with pathology-proven fulminant lymphocytic myocarditis presenting shock with elevated cardiac troponin I and ST segments in V1-2, following sustained ventricular tachycardia and a complete atrioventricular block. About 55 min of intensive cardio-pulmonary resuscitation, with extracorporeal membrane oxygenation support, bridged the patient to orthotopic heart transplantation. The explanted heart revealed diffuse lymphocytic infiltration and myocyte necrosis in all four cardiac chamber walls. Aggressive mechanical circulatory support may be an essential bridge for recovery or even transplantation in patients with fulminant myocarditis with shock.

Keyword

Fulminant Myocarditis; Complete Atrioventricular Block; Extracorporeal Membrane Oxygenation; Orthotopic Heart Transplantation
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