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DOI: 10.1055/s-0031-1297827
Successful bridging to HTx In parvovirus B19 myocarditis with posttransplant recurrent infection
Introduction: Parvovirus B19 can cause a variety of symptoms. It is usually benign in childhood, but it may also cause severe cardiogenic shock resulting in death due to fulminant myocarditis. In these cases the only therapeutical option is the implantation of a mechanical circulatory support system in order to bridge the patients to recovery or to heart transplantation.
Aims: We present here three cases of young male patients who present with hemodynamic deterioration in Parvovirus B19 associated myocarditis.
The three cardiogenic shock patients (11yrs, 31yrs and 37yrs) underwent implantation of the Berlin Heart Excor as biventricular support system. Parvovirus B19 was detected by isolation of viral DNA by PCR in myocardial samples.
The three patients could be successfully transplanted after a mean support time of 87 days. In two patients posttransplant course was uneventful. The third patient developed cardiac decompensation with consecutive resuscitation 6 days after transplantation. He was treated by NO, pharmacological therapy and intraaortic balloon pump. Myocardial biopsy of the donor heart showed a new Parvovirus B19 infection. The patient could be successfully stabilized, weaned from pharmacological and IABP support and is long-term survivor like the other two patients.
Discussion: Parvovirus B19 infection can lead to fulminant myocarditis esp. in adolescents and young adults. Often bridging to heart transplantation is the only successful treatment in these rare cases. The presented case reports underline the importance of recognizing a new Parvovirus B19 infection of the donor heart in patients developing pump failure in the posttransplant period because of viral persistance.