Heart Transplantation Under Biventricular Mechanical Circulatory Support for Fulminant Myocarditis After a Bee Sting: A Case Report

Abstract

Unusual clinical course Background:Venom related fulminant myocarditis is uncommon. The clinical course varies, and histopathology is usually unclear, however, refractory cardiogenic shock is rare. Case Report:We reported a case of a 36-year-old female who developed fever and cardiogenic shock 3 days after a bee sting. Cardiac angiography showed patent coronary arteries and severely compromised left ventricular function. Her hemodynamics remained unstable under high dose inotropic agents and intra-aortic balloon pump support.In-hospital cardiac arrest occurred 4 hours after admission and she received extracorporeal cardiopulmonary resuscitation. Her peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) was shifted to bilateral ventricular assisted devices (VAD) due to progressive right heart failure. The endomyocardial biopsy result was compatible with the picture of hypersensitivity myocarditis. Her heart went into persistent standstill under mechanical circulatory support. She underwent heart transplantation on hospital day 49 and remained clinically stable 6 months after discharge. Conclusions:This is the first reported case of fulminant hypersensitivity myocarditis following a bee sting. ECMO and VAD could be used as bridge to a successful heart transplantation.

Extracorporeal cardio-pulmonary resuscitation in poisoning: A scoping review article

“…Most of the studies (49/73, 67.1 %) were published in the last ten years, with the oldest published case dating back to 1984. 12 other publications were analysed separately due to ambiguity over the temporal sequence of events (whether ECPR was necessary to achieve ROSC or whether ROSC had been achieved with conventional CPR instead) [Supplement 2] [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , [93] .…”

“…Although this review paper focussed on survival and functional outcomes as the primary and secondary outcomes of interest, other outcomes are worth exploring. While complete myocardial recovery is often hoped for, the patient may sometimes still have severe residual cardiac function impairment necessitating further mechanical support from ventricular assist device or even orthotopic heart transplant 90 . In such extraordinary cases, ECLS should be viewed as “bridge-to-VAD/transplant” rather than as having failed.…”