Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The Usefulness of a Percutaneous Cardiopulmonary Support Device for the Treatment of Fulminant Myocarditis

전격성 심근염의 치료에 있어 경피적 순환 보조 장치의 유용성

  • Lim, Juyoug (Department of Thoracic and Cardiovascular Sugery, Seoul Asan Hospital, University of Ulsan College of Medicine) ;
  • Jung, Sung Ho (Department of Thoracic and Cardiovascular Sugery, Seoul Asan Hospital, University of Ulsan College of Medicine) ;
  • Je, Hyoung-Gon (Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Pusan National University College of Medicine) ;
  • Lee, Taek Yeon (Department of Thoracic and Cardiovascular Sugery, Seoul Asan Hospital, University of Ulsan College of Medicine) ;
  • Choo, Suk Jung (Department of Thoracic and Cardiovascular Sugery, Seoul Asan Hospital, University of Ulsan College of Medicine) ;
  • Lee, Jae Won (Department of Thoracic and Cardiovascular Sugery, Seoul Asan Hospital, University of Ulsan College of Medicine) ;
  • Chung, Cheol Hyun (Department of Thoracic and Cardiovascular Sugery, Seoul Asan Hospital, University of Ulsan College of Medicine)
  • 임주영 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 정성호 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 제형곤 (부산대학교 의과대학 양산부산대학교병원 흉부외과학교실) ;
  • 이택연 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 주석중 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 이재원 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 정철현 (울산대학교 의과대학 서울아산병원 흉부외과학교실)
  • Received : 2009.09.21
  • Accepted : 2009.11.11
  • Published : 2010.02.05
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Abstract

Background: Fulminant myocarditis is a rare, but life threatening condition. Its prognosis is related with proper management in the acute phase. A cardiopulmonary support device can be very useful in this phase. We report on our experiences with managing acute fulminant myocarditis with a cardiopulmonary support (CPS) device. Material and Method: We reviewed retrospectively 9 patients who had a CPS device used for their fulminant myocarditis between September, 2006 and October, 2008. A Capiox emergency bypass system (Terumo Inc, Tokyo, Japan) was percutaneously inserted in all the patients. Upon implantation, all the patients were in cardiogenic shock because of ventricular arrhythmia or severe left ventricular dysfunction. The mean left ventricular ejection fraction (EF) was $20{\pm}6%$ according to transthoracic echocardiography. Result: 3 patients died despite CPS. The CPS was bridged to a transplanted heart in one patient. The rest were successfully explanted after a mean time of $107{\pm}70$ hours of running. The mean EF after discharge was $56{\pm}7%$ without dilated cardiomyopathy. Conclusion: Fulminant myocarditis can be fatal, but its prognosis is excellent if these patients receive proper, timely treatment. A cardiopulmonary support device can be very useful in this acute period. However, the implantation and management protocol of cardiopulmonary support are not yet settled. Further study is necessary to lower the complications of cardiopulmonary support for patients with fulminant myocarditis.

배경: 전격성 심근염은 드물지만 사망을 초래할 수도 있는 치명적인 질병으로서, 급성기 치료가 예후에 매우 중요한 것으로 알려져 있고 이러한 급성기 치료에 순환 보조 장치가 도움이 될 수 있다. 이에 전격성 심근염 환자에서 급성기에 순환 보조 장치를 사용하여 치료한 결과를 보고하고자 한다. 대상 및 방법: 2006년 9월부터 2008년 10월까지 전격성 심근염으로 순환 보조 장치를 삽입한 9명의 환자를 대상으로 후향적 연구를 시행하였다. Capiox emergency bypass system (Terumo Inc, Tokyo, Japan)을 사용하였고 경피적으로 삽입하여 순환 보조 장치를 운용하였다. 환자들은 모두 심실 빈맥 또 는 강심제에 반응하지 않는 심인성 쇼크 상태에서 순환 보조를 받았고 심초음파상 평균 심구출률은 $20{\pm}6%$였다. 결과: 3명이 순환 보조 장치를 유지하던 도중 사망하였고 한 명의 환자가 순환 보조 장치를 유지하던 중 심장 이식 수술을 받았다. 나머지 환자들은 평균 $107{\pm}70$시간 순환 보조 장치 유지 후 성공적으로 발관하여 퇴원 후 심초음파상 심구출률 $56{\pm}7%$로 경과 관찰 중이다. 결론: 전격성 심근염은 급성기에 매우 치명적일 수 있으나 치료 후 예후는 양호한 질환으로 이러한 급성기 치료에 순환 보조 장치가 매우 유용하게 사용될 수 있다. 또한 순환 보조 장치의 도입 시점, 운용 방법 등에 대한 연구를 통하여 합병증을 줄일 수 있도록 노력해야 할 것이다.

Keywords

References

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