Хронический миокардит тяжелого течения, верифицированный как гигантоклеточный: неизбежный выбор в пользу трансплантации сердца

Abstract

Myocarditis has polymorphic clinical manifestations and is one of the main causes of heart transplantation. We\xa0present a clinical case of a 43-year-old female patient who was admitted to the clinic with biventricular heart\xa0 failure (NYHA class 3–4). She periodically noted exacerbations of bronchitis against the background of prolonged\xa0smoking. Twenty-one months prior to hospitalization, she first noted a shortness of breath without an obvious\xa0connection with the infection. Her ejection fraction (EF) decreased to 34%, pleural and pericardial effusion was\xa0revealed. Coronary angiography found no abnormalities. However, MRI showed subendocardial contrasting of the left ventricular (LV) apex. The diagnosis was myocarditis. Within six months, the patient received therapy with\xa030 mg/day prednisolone and cardiotropic therapy. Her shortness of breath intensified, and the lower extremities\xa0swelled. Examination in the clinic showed a sharp decrease in QRS voltage, QS complexes in the V1–V6 leads,\xa0dilation of all heart chambers, thrombus in the LV apical aneurysm, 16% EF, 3.9 cm VTI, 454 mmHg dp/dt, and\xa0a sharp increase in anticardiac antibody titers (up to 1:320). Endomyocardial biopsy was not performed due to\xa0the patient’s rapidly deteriorating condition, the need for cardiotonics, and signs of multiple organ failure. She\xa0was transferred to Shumakov National Medical Research Center of Transplantology and Artificial Organs, where\xa0extracorporeal membrane oxygenation was performed; orthotopic heart transplant was successfully performed.\xa0The patient’s condition was stable for the next year. Investigation of the explanted heart revealed a picture of giant\xa0cell myocarditis. Issues of diagnosis, possibility of a long-term chronic course, as well as methods of treatment\xa0of this variant of myocarditis, including the key role of heart transplantation, are discussed.