50: Surviving Acute Fulminant Myocarditis: A Case Report on ECMO and Advanced Surgical Interventions

Introduction: This report outlines the successful management of a 44-year-old male with acute fulminant myocarditis, utilizing extracorporeal mechanical oxygenation (ECMO). Case Presentation: The patient, a known case of type 2 diabetes mellitus, hyperlipidemia, and ischemic heart disease (IHD)with previos PCI, presented with severe chest pain radiating to the left arm, diaphoresis, and dyspnea. His history included fever, cough, and sore throat one week prior to admission. Initial investigations revealed poor left ventricular (LV) systolic function with an ejection fraction (EF) of 15-20% and pericardial effusion on echocardiography. Due to the patient’s critical condition, he was transferred to our facility for ECMO initiation to stabilize his vitals. Despite ECMO, the patient showed no clinical improvement, prompting a diagnostic coronary angiography (CAG), which revealed no significant coronary artery disease. Follow-up echocardiography showed moderate pericardial effusion with thick fibrin strands. The patient subsequently underwent a sub-xiphoid pericardial window, followed by a right anterior mini-thoracotomy for partial pericardium resection and debridement of thick pericardial fluid. His clinical condition deteriorated despite our management and was hence referred for possible transplant. As the CT chest and the Echocardiogram demonstrated significant pericarditis with restrictive physiology, he was turned down initially for transplant and was advised to optimally stabilise the patient. Further to discussing with the patients’ relatives for a very high risk surgery, patient underwent an open pericardiectomy via a midline sternotomy. Postoperatively, his EF improved, and ECMO support was discontinued after three days. However, complications arose, including acute kidney injury requiring dialysis, elevated liver enzymes (which later normalized), and thrombocytopenia secondary to sepsis. The patient also underwent a tracheostomy due to prolonged intubation. Despite these complications, the patient was discharged in stable condition with significant improvement in cardiac function. He will continue to be followed as an outpatient for ongoing rehabilitation and cardiac monitoring.