TY - JOUR
T1 - Extracorporeal membrane oxygenation in the management of cardiac failure secondary to myocarditis
AU - Cofer, Barry R.
AU - Warner, Brad W.
AU - Stallion, Anthony
AU - Ryckman, Frederick C.
PY - 1993/5
Y1 - 1993/5
N2 - While most patients with viral myocarditis have a relatively uncomplicated clinical course, a small number of patients will present with cardiogenic shock unresponsive to standard medical therapy. We describe the clinical course of three patients who developed profound cardiac failure secondary to a documented viral myocarditis. Each patient was managed using venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support using the right common carotid artery/internal jugular vein for cannulation. While undergoing ECMO support, each patient developed elevated left-sided cardiac chamber pressures with resultant pulmonary edema. This was managed by balloon atrial septostomy in two cases and combined blade/balloon atrial septostomy in one case. Excellent decompression of the left heart was achieved in each patient. Two patients were successfully weaned from ECMO and are currently alive, with one demon-strating residual cardiac dysfunction. One patient developed global myocardial necrosis and ultimately died. This small series demonstrates a role for ECMO in the management of cardiac failure due to acute viral myocarditis unresponsive to medical therapy. Our experience also suggests that balloon atrial septostomy may be useful to decompress the left atrium and ventricle of patients with acute myocarditis while on ECMO.
AB - While most patients with viral myocarditis have a relatively uncomplicated clinical course, a small number of patients will present with cardiogenic shock unresponsive to standard medical therapy. We describe the clinical course of three patients who developed profound cardiac failure secondary to a documented viral myocarditis. Each patient was managed using venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support using the right common carotid artery/internal jugular vein for cannulation. While undergoing ECMO support, each patient developed elevated left-sided cardiac chamber pressures with resultant pulmonary edema. This was managed by balloon atrial septostomy in two cases and combined blade/balloon atrial septostomy in one case. Excellent decompression of the left heart was achieved in each patient. Two patients were successfully weaned from ECMO and are currently alive, with one demon-strating residual cardiac dysfunction. One patient developed global myocardial necrosis and ultimately died. This small series demonstrates a role for ECMO in the management of cardiac failure due to acute viral myocarditis unresponsive to medical therapy. Our experience also suggests that balloon atrial septostomy may be useful to decompress the left atrium and ventricle of patients with acute myocarditis while on ECMO.
KW - Myocarditis
KW - atrial septostomy
KW - extracorporeal membrane oxygenation (ECMO)
UR - http://www.scopus.com/inward/record.url?scp=0027287978&partnerID=8YFLogxK
U2 - 10.1016/0022-3468(93)90028-J
DO - 10.1016/0022-3468(93)90028-J
M3 - Article
C2 - 8340855
AN - SCOPUS:0027287978
SN - 0022-3468
VL - 28
SP - 669
EP - 672
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 5
ER -