The patient´s state of health, mainly in fulminant and giant cell myocarditis, may be sometimes very severe and pharmacological treatment itself is not sufficient in some situations. In such cases, physicians get provide mechanical support of the patient´s organs with the goal of improving the patient´s state of health or to “buy some time” for other treatment.
This type of treatment contains several and different possibilities. It could be artificial lung ventilation and oxygenation, when the role of the lungs and the distribution of oxygen and other gases in the body is partially or completely replaced with mechanical support.
VAD (ventricular assist devices) are also a part of mechanical supports mechanisms. It could be translated as a device to support heart ventricles. Mostly so called LVAD (support of the left ventricle) is used. It is a device that pumps blood from the left ventricle to the aorta and from here the blood is distributed to the body. At the same time, drugs against coagulation are indicated.
Another device is intra-aortal balloon pump, in which a balloon that is placed into the aorta (see picture 4 in Definition of myocarditis). The balloon blows up out and it causes the amount of blood flowing into the body to be increased and at the same time the load for the heart is decreased.
One of the other possibilities is ECMO (extracorporeal – “out of the body” membrane oxygenation). The mechanism of function is similar to extracorporeal circulation. One catheter leads blood out of the body. Blood then flows through the oxygenator and then it is returned to the body with another catheter.
Only in very exceptional cases, heart transplant is a part of myocarditis treatment (mainly in giant cell myocarditis). It is in a situation, when the function of the heart is very poor and the ejection fraction is under 20 % and when patient is getting worse despite other treatment possibilities. Very often, patients with uncontrollable dilated cardiomyopathy are indicated to the heart transplant. In some cases, dilated cardiomyopathy may be connected with previous myocarditis. The heart transplant is definitely not a routine treatment of myocarditis. It is indicated only in very severe cases.
Author of the opening picture: Patrick J. Lynch