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J Thorac Cardiovasc Surg 2003;126:2072-2074
© 2003 The American Association for Thoracic Surgery

Brief communication

Ventricular assist surprise: giant cell myocarditis or sarcoidosis?

S. C. Stoica, AFRCSa, M. Goddard, MRCPatha, S. Tsui, FRCSa, J. Dunning, FRCSa, K. McNeil, FRACPa, J. Parameshwar, MRCPa, Stephen R. Large, FRCSa,*

a Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom

Received for publication December 21, 2002; accepted for publication January 27, 2003.

* Address for reprints: Stephen R. Large, FRCS, Consultant Cardiothoracic Surgeon, Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, United Kingdom
stephenrlarge@hotmail.com

The first 20% of the full text of this article appears below.

Idiopathic giant cell myocarditis (GCM) is a rapidly fatal disease with a worse natural history than lymphocytic myocarditis.1 Transplantation is the best available therapy, despite the risk of disease recurrence in the allograft. However, patients with GCM often die before a donor heart becomes available.2 Mechanical assist for acute myocarditis dramatically improves the natural history of the underlying disease. Particularly when the picture is of lymphocytic myocarditis, there is a good chance of successful bridge to recovery.3 There are no reported cases of bridge to recovery for GCM, and the world experience of bridge to transplant totals 9 cases. Furthermore, the outcome of these patients was poorer than that of other patients with GCM who underwent transplantation without prior requirement of a ventricular assist device (VAD).2

Secondary GCM is associated with other systemic illnesses (eg, sarcoidosis).4 From a clinical and pathologic standpoint, idiopathic GCM and cardiac sarcoidosis (CS) are considered different entities.5 We present a case that challenges this traditional view.

Clinical summary

A 36-year-old previously healthy man presented to the local hospital with a 1-week history of breathlessness and malaise. An echocardiogram showing a globally dilated heart, with . . . [Full Text of this Article]




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