[Successful management of a man with fulminant myocarditis using percutaneous cardiopulmonary support]

Fulminant myocarditis is a fetal disease characterized by a distinct viral prodrome, sudden onset of severe hemodynamic compromise, and marked myocardial inflammation. One possible therapy to improve the poor prognosis of such patients may be the implantation of circulatory support systems that allow myocardial recovery. We report here successful management of a patient with fulminant myocarditis using percutaneous cardiopulmonary support (PCPS), intra-aortic balloon pump (IABP), and continuous hemodiafiltration (CHDF). A 37-year-old Japanese man suddenly experienced cardiopulmonary dysfunction shortly after general fatigue, and was diagnosed as having fulminant myocarditis. PCPS was immediately initiated because catecholamine infusion and IABP were not enough to support circulation. Although severe dyskinesis was observed on his admission, cardiac function recovered twelve days after PCPS initiation with ejection fraction from 16% to 73%. Renal and hepatic failure also recovered with the improvement of cardiac function. We describe our clinical experiences in cardiogenic shock after acute fulminant myocarditis and discuss therapeutic guidelines for the use of PCPS, with its management and complications.