This kind of therapy is indicated in the fulminant course of myocarditis and patients with cardiogenic shock with haemodynamic instability despite the optimal therapy [43, 127]. It serves as “bridge to recovery or bridge to transplant” [96]. From mechanical supports, there are used left or both-sided cardiac supports and extracorporeal membrane oxygenation (ECMO), [127, 157].

Specifically, in ECMO, a relatively high efficiency was proved in studies with both children and adults [110, 158, 159, 160]. In a multicentric study with 255 children with myocarditis [158] in which ECMO therapy was indicated, 61 % (155 children) lived to be discharged from the hospital. Remaining 100 cases included cases of children who were disconnected from ECMO, but afterward, they died, or multiorgan failure developed or they underwent a heart transplant. Complications during the ECMO therapy (renal dysfunction and arrhythmias) and female gender were marked as a predictor of mortality in this study.

In a study of 75 adult and children patients (with the representation of 32 %) the survival probability reached 64 %. There were also described some predictors of mortality, specifically renal dysfunction, neurological complications and the situation when even after 48 hours after the connection to ECMO, troponin T level did not reach its peak [159].

Survival rate when ECMO was indicated in other studies reached also levels around 70 % [110, 160]. In the last-mentioned study, there was investigated also the psychological development of patients after ECMO therapy. One-third of patients stated anxiety, depression or posttraumatic stress disorder.

The heart transplant is indicated just in cases of advanced heart disease accompanied by considerable symptomatology of a patient when there are exhausted all possibilities of pharmacological and non-pharmacological therapy [16, 26, consultation with Assoc. prof. Kuchynka, M.D., Ph.D.].

In 2013 [161], there was published a work evaluating the incidence of acute rejection and survival rate in patients after a heart transplant as a result of lymphocytic myocarditis, idiopathic DCMP or ischemic CMP with the aim to compare its results with the conclusions of previously performed studies pointing at the high risk of acute rejection in patients with myocarditis [162]. Statistically significant incidence [161] of acute rejection was described in the group with suffered lymphocytic myocarditis until two years after the heart transplant in comparison with the group of patients with ischemic CMP (specifically 3,8 % of patients in “myocarditis-group” in comparison with 05 % in “ischemic CMP group”).

Worldwide, approximately 45 % of the heart transplants are performed because of idiopathic DCMP and 8 % because of myocarditis [162]. In the Czech Republic, DCMP is the most frequent cause of heart transplant, specifically in 49,2 % [163].

Author of the opening picture: Patrick J. Lynch

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References:

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26) COOPER L. T., JR., KNOWLTON K. U. Chapter 67: Myocarditis. In.: D.P., ZIPES, MANN D.L., LIBBY P., BONOW R.O. a BRAUNWALD E. (eds.). Braunwald´s Heart Disease: A Textbook of Cardiovascular medic Tenth edition. Philadelphia: Elsevier Saunders, 2015. pp. 1589–1602. ISBN 978-1-4557-5133-4.

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217) JCS Joint Working Group. Guidelines for Diagnosis and Treatment of Myocarditis (JCS 2009). Circulation Journal. 2011, 75(-), 734-743.

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159) HSU, K.H. a et al. Extracorporeal membranous oxygenation support for acute Fulminant myocarditis: analysis of a single center’s experience. European Journal of Cardio-thoracic Surgery. 2011, 40(-), 682-688.

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161) YOSHIZAWA, S. a et al. Outcome of Patients Having Heart Transplantation for Lymphocytic Myocarditis. The American Journal of Cardiology. 2013, 112(-), 405-410.

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