Fulminant myocarditis frequently results in severe hemodynamic deterioration. High-dose vasopressors or sometimes mechanical circulatory support are required. We report on two cases of fulminant myocarditis successfully treated with pulsatile extracorporeal life support (T-PLS®, Twin Pulse Life support, New heart bio.BHK, Seoul, Korea). With T-PLS, we were able to provide mechanical support to ...

Determining the etiology of cardiac dysfunction in patients with heart failure influences management and prognosis.1 Myocarditis, diagnosed by the current histopathological Dallas criteria, accounts for 10% of patients with new-onset cardiac dysfunction submitted to endomyocardial biopsy.1,2 Despite complete evaluation including history, physical examination, blood work, echocardiography, coron...

OBJECTIVES To assess the diagnostic yield, sampling errors, risks, and therapeutic implications of right ventricular endomyocardial biopsy in children with suspected or possible myocarditis. DESIGN Retrospective study. SETTING Tertiary referral centre for paediatric cardiology, cardiac surgery, heart transplantation, and mechanical circulatory support. PATIENTS AND METHODS Review of clini...

In an attempt to document the morphological progression from acute idiopathic myocarditis to end-stage dilated cardiomyopathy we studied 20 patients with a diagnosis of myocarditis who had had serial endomyocardial biopsies performed with intervals of 1 month to 2 years and whose ages varied from 6 months to 62 years. Fifteen of these patients were treated with immunosuppressive drugs for myoca...

In Chagas disease, understanding how the immune response controls parasite growth but also leads to heart damage may provide insight into the design of new therapeutic strategies. Tumor necrosis factor-alpha (TNF-alpha) is important for resistance to acute Trypanosoma cruzi infection; however, in patients suffering from chronic T. cruzi infection, plasma TNF-alpha levels correlate with cardiomy...

Acute fulminant myocarditis is a critical clinical condition with sudden onset of severe congestive heart failure followed by severe haemodynamic deterioration. Instituting early left ventricular support may improve outcome and result in better long term survival. The case of an immunocompromised patient who developed acute fulminant myocarditis in the setting of disseminated mucormycosis is pr...

The authors described a case of giant cell myocarditis treated by heart transplantation.

To the Editor: We appreciated the outstanding review by Drs Zipes and Wellens on sudden cardiac death.1 However, the authors did not mention myocarditis as a cause of sudden death. In our experience at the Forensic Institute of Paris, myocarditis accounts for '5% of sudden, out-of-hospital cardiac deaths.2 Two patterns are common. Acute myocarditis, the first type, occurs most frequently in chi...

Dilated cardiomyopathy and coronary flow reserve We read with interest the article by Rigo et al. 1 about the prognostic impact of coronary flow reserve (CFR) by Doppler echocar-diography in dilated cardiomyopathy. The authors conclude that in patients with idiopathic dilated cardiomyopathy, the prognostic role of impaired microvascular CFR has been shown to be unfavourable. In our opinion, som...

Heart failure is a leading problem in clinical cardiology. The causes are diverse, and treatment must be tailored according to underlying mechanisms. Inflammatory causes are a particular challenge. With their study, reported in this issue of iJACC, Francone et al. (2) intend to narrow the gap in our current knowledge regarding the diagnostic workup of inflammatory heart disease, particularly as...