1
|
Morimoto R, Sone T, Tsuboi H, Mukawa H, Morishima I, Uesugi M, Sasaki H, Niwa T, Izumi Y, Yamamoto T, Ichihashi K, Kanzaki Y, Nagai H, Iwata Y. A case of fulminant myocarditis associated with novel N1H1 influenza successfully treated by percutaneous cardiopulmonary support system. J Cardiol Cases 2010; 2:e106-e110. [PMID: 30524598 PMCID: PMC6265007 DOI: 10.1016/j.jccase.2010.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Revised: 04/29/2010] [Accepted: 05/10/2010] [Indexed: 11/23/2022] Open
Abstract
We report a case of fulminant myocarditis associated with N1H1 influenza virus infection. N1H1 was confirmed by a polymerase chain reaction assay and she was treated with oseltamivir phosphate. She was admitted to the hospital because of respiratory distress, however, echocardiography revealed severely depressed wall motion followed by refractory ventricular fibrillation. Extracorporeal circulation by emergent percutaneous cardiopulmonary support system was required to maintain hemodynamic stability. Cardiac function was spontaneously and gradually restored within a week. Findings from biopsy samples taken on day 1 and day 23 were consistent with acute myocarditis.
Collapse
Affiliation(s)
- Ryota Morimoto
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Takahito Sone
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Hideyuki Tsuboi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Hiroaki Mukawa
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Michitaka Uesugi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Hiromi Sasaki
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Toru Niwa
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Yuusuke Izumi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Toshihiko Yamamoto
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Kei Ichihashi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Hiroaki Nagai
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Yosuke Iwata
- Department of Pathology, Ogaki Municipal Hospital, Ogaki, Japan
| |
Collapse
|
2
|
Maejima Y, Yasu T, Kubo N, Kawahito K, Omura N, Katsuki T, Tsukamoto Y, Sugawara Y, Hashimoto S, Tsuruya Y, Hirahara T, Takagi Y, Kobayashi N, Funayama H, Ikeda N, Ishida T, Fujii M, Ino T, Saito M. Long-Term Prognosis of Fulminant Myocarditis Rescued by Percutaneous Cardiopulmonary Support Device. Circ J 2004; 68:829-33. [PMID: 15329503 DOI: 10.1253/circj.68.829] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The long-term prognosis and cardiac function of fulminant myocarditis treated with percutaneous cardiopulmonary support (PCPS) was compared with the outcome of those not treated with PCPS. METHODS AND RESULTS From 1991 to 2000, 14 patients with fulminant myocarditis (left ventricle ejection fraction (LVEF) < or =40%) were admitted to hospital. PCPS was necessary for treatment of shock in 8 (PCPS group), but not for the remaining 6 patients (non-PCPS group). In the PCPS group, 6 patients (75%) survived the critical phase and did not have any cardiac problems after discharge (range of follow-up period, 1.4-6.0 years). All patients in the non-PCPS group survived the acute phase; 1 patient had congestive heart failure 1.5 years after discharge, and another died from malignancy (follow-up period range, 2.2-9.4 years). Although the left ventricular ejection fraction (LVEF) of the PCPS group was significantly lower than that of the non-PCPS group in the acute phase, there was no significant difference in LVEF between the 2 groups in the chronic phase. CONCLUSION Patients who survive the acute phase crisis of acute myocarditis have a favorable long-term survival rate, whether or not mechanical support is used.
Collapse
Affiliation(s)
- Yasuhiro Maejima
- The Division of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, Amanuma, Omiya, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Aoyama N, Izumi T, Hiramori K, Isobe M, Kawana M, Hiroe M, Hishida H, Kitaura Y, Imaizumi T. National survey of fulminant myocarditis in Japan: therapeutic guidelines and long-term prognosis of using percutaneous cardiopulmonary support for fulminant myocarditis (special report from a scientific committee). Circ J 2002; 66:133-44. [PMID: 11999637 DOI: 10.1253/circj.66.133] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although fulminant myocarditis is known as a fatal disease, patients have been able to recover and return to normal life with the help of mechanical cardiopulmonary support. However, therapeutic guidelines for using percutaneous cardiopulmonary support (PCPS) for fulminant myocarditis have not been established, and the clinical course and long-term prognosis of such patients are still controversial issues. The present national survey considered the current situation of patients as the basis for proposing therapeutic guidelines. Thirty of 52 patients (57.7%) survived and returned to social life. Important factors concerning the prognosis were the severity and grade of cardiac and renal dysfunction, the adjusted support flow rate to enable recovery from circulatory failure, and prevention of circulatory disturbances of the legs and multiple organ failure directly associated with PCPS. With regard to the long-term prognosis of patients treated with PCPS, the readmission rate was 10%, the exacerbation rate was 3.3%, and mortality was 10% during the average follow-up period of 962 days. Optimal management of the mechanical cardiopulmonary support and curative treatment for the myocarditis further improve the outcome of this disease.
Collapse
Affiliation(s)
- Naoyoshi Aoyama
- Department of Internal Medicine and Cardiology, Kitasato University School of Medicine, Sagamihara, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Yukiiri K, Mizushige K, Ueda T, Nanba T, Tanimoto K, Wada Y, Takagi Y, Ohmori K, Kohno M. Fulminant myocarditis in polymyositis. JAPANESE CIRCULATION JOURNAL 2001; 65:991-3. [PMID: 11716253 DOI: 10.1253/jcj.65.991] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiac involvement in patients with polymyositis is usually asymptomatic and associated with a mild clinical course. A female patient with muscle weakness and cardiogenic shock, who was diagnosed with polymyositis and fulminant myocarditis, is described. A large amount of methylprednisolone, in addition to intra-aortic balloon pumping and percutaneous cardiopulmonary support, led to the recovery of her cardiac function. However, a massive cerebral embolism occurred and she died. Postmortem histopathological examination showed necroses of muscles and diffuse invasion of mononuclear cells in both the myocardium and the biceps muscle of her arm. Although the mechanism of cardiac dysfunction is not clear, immunosuppressive therapy was effective for fulminant myocarditis in the present case.
Collapse
Affiliation(s)
- K Yukiiri
- Second Department of Internal Medicine, Kagawa Medical University, Kita, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Kodama M, Oda H, Okabe M, Aizawa Y, Izumi T. Early and long-term mortality of the clinical subtypes of myocarditis. JAPANESE CIRCULATION JOURNAL 2001; 65:961-4. [PMID: 11716247 DOI: 10.1253/jcj.65.961] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The frequency of myocarditis and the prognosis for patients remains uncertain and, moreover, the clinical classification of myocarditis is controversial. From 1985 to 2000, 71 adult patients with clinically suspected myocarditis were admitted to 11 cardiovascular centers. Of these, 48 cases had histology proven myocarditis: 41 cases of lymphocytic myocarditis, 6 of giant cell myocarditis and 1 of eosinophilic myocarditis. Myocarditis was classified as acute (30 cases) or chronic (18 cases) according to the onset of the disease, and acute myocarditis was further categorized into common or fulminant type depending on whether or not patients required mechanical circulatory support in the management of heart failure (9 and 21 cases, respectively). Chronic myocarditis was divided into 3 subgroups: a persistent type lasting over 3 months after distinct onset (3 cases), a recurrent type (2 cases) and a latent form (13 cases). The early mortality of these 5 subtypes of myocarditis were acute common 22%, acute fluminant 43%, chronic persistent 33%, chronic recurrent 50%, and chronic latent 38%. The overall early mortality of all patients with myocarditis was 38% in spite of aggressive treatment during hospitalization. On the other hand, the long-term prognosis of patients with myocarditis was favorable; only 4 cases, who survived the active phase, died in the late phase: 1 had fulminant myocarditis and the other 3 had the chronic latent form. Thus, the early mortality of patients with myocarditis was very high regardless of the subtype, but if patients can survive the active phase, they have a favorable prognosis except with the chronic latent form.
Collapse
Affiliation(s)
- M Kodama
- Division of Cardiology, Niigata Graduate School of Medicine & Dental Science, Japan.
| | | | | | | | | |
Collapse
|
6
|
Miura M, Asaumi Y, Wada Y, Ogata K, Sato T, Sugawara T, Yano M, Mitsu-Oka M, Takai O, Ota K, Namiki K, Sato D, Sato E, Nagura H, Kimura T. A case of influenza subtype A virus-induced fulminant myocarditis: an experience of percutaneous cardio-pulmonary support (PCPS) treatment and immunohistochemical analysis. TOHOKU J EXP MED 2001; 195:11-9. [PMID: 11780720 DOI: 10.1620/tjem.195.11] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 64-year-old man was admitted to the emergency center of Furukawa City Hospital because of common cold-like symptoms and hypotension. He was diagnosed as fulminant myocarditis with cardiogenic shock and arrhythmia elicited by influenza virus subtype A. Cardiac angiography, echocardiography and biopsy also showed myocarditis, and serum antibody titer to influenza virus subtype A was increased to 4-fold in paired serums. Treatments of both percutaneous cardio-pulmonary support (PCPS) and intra-aortic balloon pumping (IABP) were carried out to sustain the general circulation. PCPS treatment was discontinued on the 25th day of the admission, but IABP was continued. Finally, he died of multiple organ failure. The autopsy revealed myocardial necrosis with a slight fibrosis and a small amount of lymphocytic infiltration into the ventricular wall, which were compatible with restrictive myocarditis. Moreover, immunohistochemical analysis also showed the presence of viral antigens in cardiac myocytes. This case clearly showed that PCPS and IABP can be beneficial to sustain the general circulation in fulminant myocarditis, but cardiac pumping function failed completely to recover from myocardial damage.
Collapse
Affiliation(s)
- M Miura
- Department of Internal Medicine, Furukawa City Hospital, Furukawa, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Kohno K, Aoyama N, Shimohama T, Yoshida M, Machida Y, Fukuda N, Aizaki T, Suzuki K, Kurosawa T, Izumi T. Resuscitation from fulminant myocarditis associated with refractory ventricular fibrillation. JAPANESE CIRCULATION JOURNAL 2000; 64:139-43. [PMID: 10716529 DOI: 10.1253/jcj.64.139] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Resuscitation was possible in a case of fulminant myocarditis with refractory ventricular fibrillation (Vf) using a percutaneous cardiopulmonary support system (PCPS). A 46-year old Japanese man suddenly experienced cardiopulmonary dysfunction shortly after the onset of flu symptoms, was promptly diagnosed as having fulminant myocarditis and PCPS was immediately initiated. On the second day in the hospital, refractory Vf occurred, which lasted for approximately 2h despite repeated efforts to terminate it. Finally, a large dose of steroids was administered. From the third day of hospitalization and onwards, the Vf disappeared totally. The patient completely recovered from such a serious state in 6 months. During the following 3 years, he has had no clinical symptoms of worsening. As in this case demonstrates, most myocarditis is curable and invasive measures are very helpful in rescuing patients from the fulminant type with refractory Vf.
Collapse
Affiliation(s)
- K Kohno
- Department of Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Ito M, Tanabe Y, Suzuki K, Kumakura M, Kimura K, Masani F, Aizawa Y. Left ventricular free wall rupture in acute fulminant myocarditis during long-term cardiopulmonary support. JAPANESE CIRCULATION JOURNAL 1999; 63:397-9. [PMID: 10943621 DOI: 10.1253/jcj.63.397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 77-year-old woman with acute myocarditis developed cardiogenic shock soon after admission and was given mechanical cardiopulmonary support. Echocardiography revealed severe global left ventricular hypokinesia. After 5 days of mechanical support, left ventricular wall motion gradually began to improve, but the patient died of cardiac tamponade on day 13. At necropsy, a free wall rupture was found where the apical akinetic area bordered the basal portion, an area which had shown better wall motion. Left ventricular free wall rupture in acute myocarditis has not been reported, but this case indicates that it may occur in fulminant myocarditis when a cardiopulmonary support system is used.
Collapse
Affiliation(s)
- M Ito
- First Department of Internal Medicine, Niigata University School of Medicine, Japan
| | | | | | | | | | | | | |
Collapse
|
9
|
Kawahito K, Murata S, Yasu T, Adachi H, Ino T, Saito M, Misawa Y, Fuse K, Shimada K. Usefulness of extracorporeal membrane oxygenation for treatment of fulminant myocarditis and circulatory collapse. Am J Cardiol 1998; 82:910-1. [PMID: 9781978 DOI: 10.1016/s0002-9149(98)00503-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Prognosis for fulminant myocarditis with cardiogenic shock refractory to conventional therapy is poor. This report describes mechanical circulatory support with extracorporeal membrane oxygenation as an effective alternative for treating fulminant myocarditis with circulatory collapse.
Collapse
Affiliation(s)
- K Kawahito
- Department of Cardiovascular Surgery, Jichi Medical School, Kawachi, Tochigi, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Kodama M, Okura Y, Hirono S, Hanawa H, Ogawa Y, Itoh M, Izumi T, Aizawa Y. A new scoring system to predict the efficacy of steroid therapy for patients with active myocarditis--a retrospective study. JAPANESE CIRCULATION JOURNAL 1998; 62:715-20. [PMID: 9805250 DOI: 10.1253/jcj.62.715] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The efficacy of steroid therapy for active myocarditis is controversial, so a new scoring system was constructed based on 6 clinical parameters: (1) the mode of onset of the disease; (2) complications of immune-related systemic disorders; (3) evidence of viral infection; (4) the population of infiltrating inflammatory cells; (5) the appearance of multinucleated giant cells in endomyocardial biopsy specimens; and (6) the duration of active myocarditis. Points from -2 to +2 were assigned to each parameter and the total score was calculated from the 6 parameters. Twenty-one patients with clinically suspected myocarditis, who had been admitted to hospital from 1987, were retrospectively analyzed by this scoring system. Sixteen patients were treated without corticosteroids at presentation, and 5 patients were treated by conventional methods with adjunctive use of corticosteroids. In 10 patients of the non-steroid group myocarditis improved and their mean score was -4.8 at presentation. In 6 patients of the non-steroid group, myocarditis and cardiac symptoms persisted after initial therapy, and their score at presentation was -0.8. In 2 patients of the steroid group myocarditis improved after initial therapy and their score was +2. In 2 other patients of the steroid group, myocarditis and cardiac symptoms persisted and their score was +3. Another patient of the steroid group died from congestive heart failure and his score was -5 at presentation. In 8 of 9 patients with persistent myocarditis, the secondary phase therapy was challenged. Seven patients were treated with corticosteroids and 6 patients improved. Their score at the secondary phase was +2.5. Overall, non-steroid conventional treatment was successful in patients with the scores from -5 to -4, and steroid therapy succeeded in patients with scores from 0 to +6. Although this is a retrospective study, this scoring system is able to predict the efficacy of steroid therapy in patients with clinically suspected active myocarditis.
Collapse
Affiliation(s)
- M Kodama
- First Department of Internal Medicine, Niigata University School of Medicine, Japan
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Yasu T, Murata S, Katsuki T, Fujii M, Kubo N, Ohmura N, Ino T, Saito M. Acutely severe myocarditis successfully treated by percutaneous cardiopulmonary support applied by a newly developed heparin-binding oxygenator and circuits. JAPANESE CIRCULATION JOURNAL 1997; 61:1037-42. [PMID: 9412869 DOI: 10.1253/jcj.61.1037] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The feasibility of using the heparin-bound percutaneous cardiopulmonary support system (PCPS) for prolonged extracorporeal circulation in patients with acute severe myocarditis is demonstrated. The case histories of 2 patients with cardiogenic shock caused by acute myocarditis are presented; both were successfully treated with long-term PCPS using a newly developed heparin-binding oxygenator and circuits without changing the oxygenator. The courses of both patients remain uneventful more than 12 months after discharge. We also discuss the clinical aspects of using heparin-bound PCPS in patients with acute severe myocarditis.
Collapse
Affiliation(s)
- T Yasu
- Cardiovascular Division, Omiya Medical Center, Jichi Medical School, Japan
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Nagai N, Ogura R, Seki A, Kajiyama M, Masumoto H, Sasaki M. Cardiac rescue of an infant with fulminant myocarditis using extracorporeal membrane oxygenation. JAPANESE CIRCULATION JOURNAL 1996; 60:699-702. [PMID: 8902588 DOI: 10.1253/jcj.60.699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 7-month-old boy presented with fulminant myocarditis. He was in cardiac shock and cardiac dysfunction progressed despite aggressive support. Extracorporeal membrane oxygenation (ECMO) was applied for 8 days and he recovered with mild dilated cardiomyopathy.
Collapse
Affiliation(s)
- N Nagai
- Department of Pediatrics, Okazaki Municipal Hospital, Japan
| | | | | | | | | | | |
Collapse
|