Use of Central VA-ECMO with Left Ventricular Vent for Successful Management of Fulminant Dengue Myocarditis

Dengue fever (DF) is an acute viral illness caused by ribonucleic acid (RNA) virus of the Flaviviridae family and spread by Aedes mosquitoes.Patient symptoms vary from asymptomatic fever to dreaded complications such as hemorrhagic fever and shock.Of the 2.5 billion people globally at risk of DF and its severe forms dengue hemorrhagic fever and dengue shock syndrome (DSS), South-East Asia accounts for approximately 1.3 billion or 52% of reported cases.Progressive worsening shock, multiorgan damage, and disseminated intravascular coagulation account for a high mortality rate associated with DSS.Cardiac manifestations of DF can present with mildly elevated cardiac enzymes to severe myocarditis, leading to congestive heart failure, arrhythmias, cardiogenic shock, and death.Activation and release of proinflammatory cytokines, T-cells, vasoactive substances, and vascular injury lead to increased vessel wall permeability and capillary leakage, causing a reduction in effective preload and myocardial tissue edema.We present a case report of a young girl diagnosed with DF needing veno-arterial extracorporeal membrane oxygenation with a left ventricular vent to treat her cardiac failure.