A successful rescue of juvenile fulminant myocarditis by extracorporeal membrane oxygenation combined with intra-aortic balloon pump: a case report

Abstract

Myocarditis refers to myocardial inflammatory damage, and it can have various causes. Myocarditis can lead to impaired cardiac function, including decreased systolic and diastolic function and arrhythmia. When myocarditis occurs suddenly and rapidly progresses to severe heart failure, hypotension, cardiogenic shock, or severe arrhythmia, it can be diagnosed as fulminant myocarditis (FM). Our hospital recently admitted a case of juvenile FM, a 17-year-old male, who was admitted to the hospital for "intermittent chest tightness and asthma for 10 days". When the patient was hospitalized, he complained of chest tightness, palpitation, shortness of breath, fatigue, and dyspnea. Wet rales could be heard in both lungs on auscultation, as well as arrhythmia. Echocardiograms indicated an ejection fraction of 10%. Laboratory tests showed liver and kidney dysfunction as well as abnormal coagulation function. After admission, he was treated with drugs including cardiotonic, diuretic, hormonal, antiviral drugs, and drugs affecting immune regulation. After tracheal intubation-assisted ventilation, the patient's symptoms did not significantly alleviate, and then veno-arterial extracorporeal membrane oxygenation (V-A ECMO) combined with an intra-aortic balloon pump (IABP) were used to assist in the treatment of cardiopulmonary failure. After the treatment, the patient's hemodynamics were stable, the respiratory and circulatory functions were restored, and the ECMO and IABP were successfully removed. The patient's review results were satisfactory, and he was discharged without delay. Although ECMO has no direct therapeutic effect on myocarditis, it can quickly stabilize hemodynamics, improve systemic tissue perfusion, reduce the use of high-dose vasoactive drugs and effectively assist patients during the acute phase of myocarditis. The authors believe that ECMO is the first choice for the treatment of FM in adolescents. Here we summarize our experience at our hospital with the treatment of FM using life support methods.

Keywords: Fulminant myocarditis (FM); case report; extracorporeal membrane oxygenation (ECMO); intra-aortic balloon pump (IABP).