Ann Thorac Surg 1997;63:1146
© 1997 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
William L. Holman, MD
Division of Cardiothoracic Surgery, University of Alabama at Birmingham, UAB Station, Birmingham, AL 35294-0007
See also page 1145.
Myocarditis remains a difficult disease to manage. It can be caused by a variety of conditions, and often progresses to severe cardiac failure and death despite optimal medical therapy. The diagnostic methodology available to define the cause of myocarditis is not well developed at present, although investigators are actively pursuing methods to distinguish infectious from autoimmune disease states. In the near future, immunomodulation guided by novel diagnostic methods may improve the results of treatment for myocarditis.
This valuable case report by Martin and associates adds to the list of patients with myocarditis and profound circulatory failure who were successfully treated with ventricular assist devices (VADs) pending recovery of the native heart. Several types of VADs are now commercially available, and mechanical circulatory assistance should be considered in the treatment of all patients with severe heart failure resulting from myocarditis. There are several important decisions that must be made before placing a VAD in a patient with myocarditis. Is the patient a candidate for cardiac transplantation? This question must be carefully answered because some patients with myocarditis will not recover cardiac function despite VAD support. Second, should the patient have left ventricular or biventricular support? Third, at what point does one decide that cardiac recovery is very unlikely and proceed with transplantation? Recovery can take weeks to months, yet serious complications (eg, infection or stroke) can occur while the patient is being supported. The appropriate timing for transplantation will be defined more precisely by improvements in the diagnosis of myocarditis and further experience with VADs, but will likely move toward longer periods of support as changes in VAD design and advances in the management of VAD patients make the use of these life-saving devices safer.
Related Article
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MEDOS HIA-VAD Biventricular Assist Device for Bridge to Recovery in Fulminant Myocarditis
- Juergen Martin, Koppany Sarai, Michael Schindler, Andreas van de Loo, Michio Yoshitake, and Friedhelm Beyersdorf
Ann. Thorac. Surg. 1997 63: 1145-1146.
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