COVID-19 Related Myocarditis in a Pediatric Patient: Venoarterial Extracorporeal Membrane Oxygenation and Concomitant Impeller Pump Implantation for Left Ventricular Unloading

Background: We present the case of a 7-year-old girl (15 kg and 135 cm) with SARS-CoV-2 infection who developed severe heart failure due to myocarditis and acute respiratory distress syndrome resulting in multisystem inflammatory syndrome in children (MIS-C) requiring extracorporeal membrane oxygenation (ECMO) support.

Method: Due to a massively dilated left ventricle (LV), LV unloading was required. The only appropriate treatment for such a petite child was off-label implantation of the smallest available impeller microaxial flow pump. After placement in the LV, a flow of 0.9 to 1.1 L/min could be generated. A significant improvement of hemodynamics and sufficient unloading of the LV was observed. The impeller pump could be removed 6 days after initial implantation. Sadly, the medical condition of the child deteriorated due to COVID-19-associated MIS-C, therapy was ceased, and the patient died in multiorgan failure.

Results and Conclusion: The combination of venoarterial ECMO (VA-ECMO) and concomitant impeller pump implantation (ECMELLA) for left ventricular unloading in adult patients with cardiogenic shock has already been advocated to improve outcome. Due to the relatively large dimensions of already existing microaxial pumps (for adults), the introduction of ECMELLA in children with severe cardiovascular failure is still a long way off. Smaller devices adjusted to pediatric parameters and proportions should be developed as soon as possible for better treatment of children in need of mechanical support. This would be of great interest and an enormous benefit for both patients and physicians.

Publication History

Article published online:
12 February 2022