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Abstract: Poster Presentations |

MANAGING LIFE THREATENING VIRAL MYOCARDITIS WITH DILATED CARDIOMYOPATHY BY DROTRECOGIN ALFA AND CIRCULATORY ASSISTED DEVICES FREE TO VIEW

Tsung P. Tsai, PhD*; Shyh M. Tsao, MD; Yi L. Wu, MD; Jung M. Yu, MD; Kuei C. Chan, MD; Kwo C. Ueng, MD
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Chung Shan Medical University Hospital, Taichung, Taiwan ROC


Chest


Chest. 2005;128(4_MeetingAbstracts):275S. doi:10.1378/chest.128.4_MeetingAbstracts.275S-b
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Abstract

PURPOSE:  Acute fulminant myocarditis with dilated cardiomyopathy caused by Parvovirus B19 may present with cardiogenic shock refractory to the maximum dose of inotropics and intra-aortic balloon pumping (IABP). The benefits of extracorporeal membrane oxygenation (ECMO) support for patients with life-threatening myocarditis has been established. Drotrecogin alfa, recombinant human activated protein C, has antithrombotic, anti-inflammatory and profibrinolytic properties. The effectiveness from the circulatory support (ECOM or IABP) and activated protein C use in managing acute myocarditis with dilated cardiomyopathy caused by Parvovirus B19 has to be defined.

METHODS:  Four patients( 2 male, 2 female, mean age 37.2 years) presented with congestive heart failure 3 to 4 days after flu-like symptoms (intermittent fever 38∼39°C, dyspnea and chest tightness). Chest roentgenograms showed cardiomegaly and bilateral pulmonary infiltrates. EKG revealed non-specific ST wave changes. 2-D echocardiograms demonstrated severe myocardial dysfunction with LVEF, measured between 18.4 to 22% (mean, 19.5%). Coronary angiography was performed in each patient and excluded ischemic heart disease. Acute decompensation with more than 2 organ failure (heart and lungs) and unresponsive to more than 2 inotropics and acute respiratory therapy were indications for the use of circulatory support by IABP (3pts) and/or ECMO (3pts) as well as activated protein C (3pts). Serological test and myocardial biopsy for Parvovirus B19 was positive in 3 pts and one pt, respectively.

RESULTS:  All three pts with ECMO and IABP support were weaned. Follow-up LVEF measured were 53%, 53%, 55% and 60%, respectively. However one pt died one month later because the deterioration of her SLE condition and repeated infection. There were no neurologic sequelae in survivors.

CONCLUSION:  Use of circulatory support and activated protein C is an effective alternative for treating life-threatening viral myocarditis with dilated cardiomyopathy, especially caused by Parvovirus B19 virus.

CLINICAL IMPLICATIONS:  Parvovirus B19virus can cause severe myocarditis with dilated cardiomyopathy and circulatory collapse. Combined use of Drotrecogin alfa and ECMO and/or IABP is an effective novel therapy for this cohort of patients.

DISCLOSURE:  Tsung Tsai, None.

Wednesday, November 2, 2005

12:30 PM - 2:00 PM


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