Surgical interventions are needed in myocarditis when the condition of the patient is not improved through conventional treatment. Myocarditis, if progresses, causes serious implications including heart failure.
Treatment of myocarditis depends upon the severity of the disease. In some cases, the symptoms are mild while in other cases, myocarditis is fulminant. Most cases of myocarditis do not require any treatment. The treatment, if required, focusses on the cause of the condition and managing the symptoms. Various drugs are used to improve the capacity of the heart. Drugs used are Beta-blockers, ACE inhibitors, Angiotensin II receptor blockers and diuretics. In severe cases of myocarditis, surgery is required.(2)
Is There Any Surgery For Myocarditis?
In some of the patients, conventional treatment failed to treat the patients. This leads to the progression of the symptoms of myocarditis resulting in fatal complications. In its advanced stage, the patient may have heart failure. In these circumstances, surgery is the only option left for the patient. Following are the surgical options available for the patient suffering from myocarditis:
Ventricular Assist Device. Myocarditis is the condition in which the muscles of the heart get inflamed and are not able to perform the physiological function of pumping the blood. Due to the inability of the muscles to pump blood, other organs of the body get deprived of oxygen and nutrition leading to various symptoms. Thus, a device is attached to the heart that helps in the pumping of blood. This device is an electromechanical device that can be placed completely inside the body of partially inside and partially outside the body. This device is capable of assisting the heart by performing a partial function or completely replaces the failing cardiac function. These devices can be used for long term or short term. The long-term use of the ventricular assist device is to make a bridge to transplantation, i.e. to keep the patient alive till the patient waits for heart transplantation.
Intra-Aortic Balloon Pump. The intra-aortic balloon pump is used to assist the heart in the pumping of the blood. According to a study, mortality in the myocarditis with cardiogenic shock can be reduced by using a balloon pump. During this surgery, a balloon is placed in the aorta through cardiac catheterization from the artery in the groin. The inflation and deflation of the balloon are adjusted to the heartbeat. Thus, during every heartbeat, the balloon will inflate and deflate, allowing the blood to flow more effectively.
Heart Transplantation. Heart transplantation is required in the patient who has severe damage to the heart due to myocarditis. The muscles of the heart are not able to pump the blood and the conventional treatment failed to alleviate the symptoms of myocarditis. The common procedure for heart transplantation is to take the heart of a recently deceased donor, ideally a brain-dead patient and transplant it in the patient. Generally, the damaged heart of the patient is removed to make space for the new heart. In rare cases, the heart of the patient is not removed so that it can support the new heart.
Extracorporeal Membrane Oxygenation. Extracorporeal membrane oxygenation is short-term support through a machine; in patients whose heart and lungs are damage to an extent that they are no longer perform their function of providing oxygen to other body parts. In this process, the carbon dioxide from the blood is artificially removed and the red blood cells are oxygenated outside the body with the help of a machine. The technique is used as a bridge to either placement of a ventricular assist device or the heart transplantation.(1)
Various surgical procedures are applied in case of severe myocarditis; the choice depends on the severity of damage to the heart. Extracorporeal membrane oxygenation is the method of removing carbon dioxide and infusing oxygen in the blood, while the ventricular assist device is used to help pump the blood. A heart transplant is another option for patients with severe myocarditis.