Cardiovascular Journal of Africa: Vol 29 No 3 (May/Junel 2018)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 3, May/June 2018

AFRICA

Case Report

Levitronix bilateral ventricular assist device, a bridge to

recovery in a patient with acute fulminant myocarditis

and concomitant cerebellar infarction

Yi-Fan Huang, Po-Shun Hsu, Chien-Sung Tsai, Yi-Ting Tsai, Chih-Yuan Lin, Hong-Yan Ke, Yi-Chang Lin,

Hsiang-Yu Yang

Abstract

We report on the case of a 27-year-old male who presented to

our emergency room with chest tightness, dyspnoea and cold

sweats. The 12-lead electrocardiogram showed diffuse ventricu-

lar tachycardia with wide QRS complexes. Troponin-I level

was elevated to 100 ng/ml. The coronary angiogram showed

good patency of all three coronary vessels, and acute fulminant

myocarditis was suspected. The patient underwent cardio-

pulmonary resuscitation in the catheter room and high-dose

inotropic support was initiated to stabilise his haemodynamic

status. After resuscitation, the patient was in a coma and acute

stroke was highly suspected. In addition, deteriorating cardio-

genic shock with acute renal failure and pulmonary oedema

were also detected. Due to haemodynamic compromise despite

high-dose inotropic support, a Levitronix

bilateral ventricu-

lar assist device (Bi-VAD) was implanted on an emergency

basis for circulatory support. Postoperative brain computed

tomography revealed acute left cerebellar infarction. Because

the patient had left cerebellar infarction with right hemiple-

gia, heart transplantation was contraindicated. Eventually,

cardiac systolic function recovered well and the patient under-

went successful Bi-VAD removal after a total of 18 days on

Levitronix

haemodynamic support. He was weaned from the

ventilator two weeks later and was discharged 10 days later.

Keywords:

ventricular assist device, acute myocarditis, cerebellar

infarction

Submitted 1/1/17, accepted 22/1/18

Published online 7/2/18

Cardiovasc J Afr

2018;

: e1–e4

www.cvja.co.za

DOI: 10.5830/CVJA-2018-009

In the past two decades, intra-aortic balloon pump and

extra-corporeal membrane oxygenation (ECMO) have been

predominantly used at our centre as a bridge, either to cardiac

transplantation or to recovery in patients with decompensated

heart failure.

1,2

However, most patients die because of either

ECMO-related morbidity or systemic malperfusion if cardiac

function does not recover in time and cardiac transplantation

is contraindicated in this period.

In such patients, Levitronix

bilateral ventricular assist device (Bi-VAD) could provide

temporary cardiac support for a much longer period than

ECMO.

Our experience with this case indicates that timely

implantation of Bi-VAD can function as a bridge to recovery

in patients with acute fulminant myocarditis, particularly when

heart transplantation is contraindicated.

Case report

A 27-year-old man was brought to our emergency room with

a history of chest tightness, dyspnoea and cold sweats that had

manifested a few hours earlier. However, the symptoms did not

ameliorate with rest. He denied any systemic disease, except a

common cold one week earlier.

The 12-lead electrocardiogram (ECG) showed diffuse

ventricular tachycardia with wide QRS complexes. Troponin-I

levels were elevated to 100 ng/ml. An emergency coronary

angiogram showed good patency of all three coronary vessels,

and acute fulminant myocarditis was suspected.

His haemodynamic status suddenly deteriorated because

of ventricular fibrillation shortly after the angiogram, and

cardiopulmonary resuscitation was performed for 30 minutes.

His vital signs were restored after initiation of high-dose

inotropic support with multiple inotropic agents (dopamine:

15 mcg/kg/min, dobutamine: 15 mcg/kg/min, norepinephrine:

32 mcg/min and epinephrine: 1 mcg/min). Because his vital

signs were unstable during the coronary angiogram, we did not

Division of Cardiovascular Surgery, Department of Surgery,

Tri-Service General Hospital, National Defense Medical

Centre, Taipei, Taiwan, Republic of China

Yi-Fan Huang, MD

Po-Shun Hsu, MD,

hsuposhun@yahoo.com.tw

Chien-Sung Tsai, MD

Yi-Ting Tsai, MD

Chih-Yuan Lin, MD

Hong-Yan Ke, MD

Yi-Chang Lin, MD

Hsiang-Yu Yang, MD

Division of Cardiovascular Surgery, Department of Surgery,

Tri-Service General Hospital Songshan Branch, Taipei,

Taiwan, Republic of China

Yi-Fan Huang, MD

Division of Cardiovascular Surgery, Department of Surgery,

Taoyuan Armed Forces General Hospital, Taipei, Taiwan,

Republic of China

Chien-Sung Tsai, MD