Giant cell myocarditis: challenge of mechanical circulatory support (RCD code: III-1B.1.o)
We report the case of a young adult male who presented with acute fulminant myocarditis, deteriorated rapidly despite intra‑aortic balloon pump and inotropic support, and received a HeartMate II continuous flow left ventricular assist device (LVAD) as a bridge to heart transplantation. The left ventricular apical core biopsy showed giant cell myocarditis. Despite treatment with steroids and immunosuppression, there was progressive left and right ventricular dysfunction, culminating in asystole and a Fontan‑like circulation dependent on LVAD flow. He developed severe right heart failure with ascites and pleural effusions, refractory to pharmacological therapy, and ultimately died due to complications of renal failure. We review the diagnosis, natural history and management of giant cell myocarditis, with a focus on challenges raised by mechanical circulatory support in this patient group. JRCD 2013; 1 (3): 23–26
Cooper LT, Berry GJ, Shabetai R. Idiopathic giant‑cell myocarditis – natural history and treatment. N Engl J Med 1997; 336: 1860–1866.
Kandolin R, Lehtonen J, Salmenkivi K et al. Diagnosis, treatment, and outcome of giant‑cell myocarditis in the era of combined immunosuppression. Circ Heart Fail 2013; 6: 15–22.
Kytö V, Saukko P, Lignitz E et al. Diagnosis and presentation of fatal myocarditis. Hum Pathol 2005; 36: 1003–1007.
Kytö V, Saraste A, Voipio‑Pulkki L‑M et al. Incidence of fatal myocarditis: a population‑based study in Finland. Am J Epidemiol 2007; 165: 570–574.
Rosenstein ED, Zucker MJ, Kramer N. Giant cell myocarditis: most fatal of autoimmune diseases. Semin Arthritis Rheum 2000; 30: 1–16.
Cooper LT. Idiopathic Giant Cell Myocarditis. In: Cooper LT, editor. Myocarditis: From Bench to Bedside. Humana Press; 2008. p. 405–420.
Cooper LT, Baughman KL, Feldman AM et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 2007; 28: 3076–3093.
Shields RC, Tazelaar HD, Berry GJ et al. The role of right ventricular endomyocardial biopsy for idiopathic giant cell myocarditis. J Card Fail 2002; 8: 74–78.
Okura Y, Dec GW, Hare JM et al. A clinical and histopathologic comparison of cardiac sarcoidosis and idiopathic giant cell myocarditis. J Am Coll Cardiol ; 41: 322–329.
Stehlik J, Edwards LB, Kucheryavaya AY et al. The registry of the International Society for Heart and Lung Transplantation: 29th official adult heart transplant report 2012. J Heart Lung Transplant 2012; 31: 1052–1064.
Davies RA, Veinot JP, Smith S et al. Giant cell myocarditis: clinical presentation, bridge to transplantation with mechanical circulatory support, and long‑term outcome. J Heart Lung Transplant 2002; 21: 674–679.
Murashita T, Sugiki T, Tachibana T et al. A case of giant cell myocarditis: bridge to recovery by long‑term mechanical circulatory support without immunosuppressive therapy. J Thorac Cardiovasc Surg 2006; 132: 432–433.
Murray LK, Gonzalez‑Costello J, Jonas SN et al. Ventricular assist device support as a bridge to heart transplantation in patients with giant cell myocarditis. Eur J Heart Fail 2012; 14: 312–318.
Schenk S, Arusoglu L, Morshuis M et al. Triple bridge‑to‑transplant in a case of giant cell myocarditis complicated by human leukocyte antigen sensitization and heparin‑induced thrombocytopenia type II. Ann Thorac Surgery 2006: 1107–1109.
Hebert A, Jensen AS, Idorn L et al. The effect of Bosentan on exercise capacity in Fontan patients; rationale and design for the TEMPO study. BMC Cardiovasc Disord 2013; 13: 36.
- There are currently no refbacks.