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      An Autopsy Case of Fulminant Myocarditis with Massive Left Ventricular Calcification

      case-report

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          Abstract

          Myocardial calcification in myocarditis is rare and may be linked to poor outcomes. We herein report a case of fulminant myocarditis with massive myocardial calcification and its pathological outcomes at autopsy. A 49-year-old man experienced chest pain and was diagnosed with acute myocarditis. His cardiac function did not recover despite mechanical circulatory support in combination with V-A extracorporeal membrane oxygenation and IMPELLA CP Ⓡ. He eventually developed sepsis and gastrointestinal bleeding and died on day 27. Diffuse myocardial calcification was observed on computed tomography at autopsy. The pathological autopsy depicted that calcification filled every myocardial cell in the left ventricle.

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          Postinfarction Myocardial Calcifications on Cardiac Computed Tomography: Implications for Mapping and Ablation in Patients With Nontolerated Ventricular Tachycardias

          Daniel Alyesh, Konstantinos Siontis, Ghaith Sharaf Dabbagh … (2019)
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            Short-Term Outcomes of Impella Support in Japanese Patients With Cardiogenic Shock Due to Acute Myocardial Infarction　- Japanese Registry for Percutaneous Ventricular Assist Device (J-PVAD).

            Yuki Ikeda, Junya Ako, Koichi Toda … (2023)
            The Impella®percutaneous left ventricular assist device has been available in Japan since 2017. This is the first large-scale registry study to analyze the efficacy and safety of Impella in Japanese patients with acute myocardial infarction with cardiogenic shock (AMICS).Methods and Results: The Japanese registry for Percutaneous Ventricular Assist Device (J-PVAD) has registered all consecutive Japanese patients treated with Impella. We extracted data for 593 AMICS patients from J-PVAD and analyzed 30-day survival and safety profiles. Overall 30-day survival was 63.1%. The 30-day survival of the Impella alone and Impella plus venoarterial extracorporeal membrane oxygenation (ECPELLA) groups was 80.9% and 45.7%, respectively. The Impella alone group was older and had a lower rate of cardiac arrest, milder consciousness disturbance, less inotrope use, lower serum lactate concentrations, higher B-type natriuretic peptide concentrations, and higher left ventricular ejection fraction (LVEF) than the ECPELLA group. Cox regression analysis revealed that older age and comorbid renal disturbance were common risk factors affecting 30-day mortality in both groups. Major adverse events were hemolysis (10.8%), hemorrhage/hematoma (7.6%), peripheral ischemia (4.4%), stroke (1.3%), and thrombosis (0.7%). LVEF improved in both groups during support.
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              Massive Biventricular Myocardial Calcification in a Patient with Fulminant Myocarditis Requiring Ventricular Assist Device Support

              Yuki Kimura, Osamu Seguchi, Atsushi K Kono … (2018)
              The natural course of myocardial calcification is unclear. We herein report a case of massive biventricular myocardial calcification associated with fulminant myocarditis and present its natural course. The patient was a 15-year-old boy. Massive calcification was detected in both ventricles on computed tomography several months after left ventricular assist device placement. Although the calcification gradually regressed, the patient's cardiac function did not recover, and he underwent heart transplantation after a waiting period of 3 years. A histological examination revealed severe fibrosis in both ventricles of the original heart. Myocardial calcification might suggest severe myocardial inflammation and injury in cases of fulminant myocarditis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Intern Med
                Journal ID (iso-abbrev): Intern Med
                Title: Internal Medicine
                Publisher: The Japanese Society of Internal Medicine
                ISSN (Print): 0918-2918
                ISSN (Electronic): 1349-7235
                Publication date (Electronic): 15 March 2024
                Publication date (Print): 15 March 2024
                Volume: 63
                Issue: 6
                Pages: 821-827
                Affiliations
                [1 ]Department of Cardiology, Iwate Prefectural Central Hospital, Japan
                [2 ]Department of Pathology, Iwate Prefectural Central Hospital, Japan
                Author notes

                Correspondence to Dr.　Masanobu Miura, masa-miura@ 123456cardio.med.tohoku.ac.jp

                Article
                DOI: 10.2169/internalmedicine.2200-23
                PMC ID: 11008995
                PubMed ID: 38494729
                SO-VID: 2f18f293-ed47-4569-b6f4-18ef03c42310
                Copyright © Copyright © 2024 by The Japanese Society of Internal Medicine
                License:

                The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit ( https://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 26 April 2023
                Date accepted : 4 June 2023
                Categories
                Subject: Case Report

                Keywords: myocarditis,myocardial calcification,mechanical circulatory support
                Data availability:
                Keywords: myocarditis, myocardial calcification, mechanical circulatory support

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