Recovery from anthracycline-induced cardiomyopathy with biventricular assist and valve repairs: A case report and literature review.
INTRODUCTION
Ventricular assist device is used in the patients with severe heart failure due to cardiotoxicity of anthracyclines, which are widely used chemotherapeutic agents for a wide range of malignant tumors. However, recovery of cardiac function is rare.


METHODS
We present the clinical course of a 43-year-old woman in remission from diffuse large B-cell lymphoma after the chemotherapy including anthracyclines, who presented in cardiogenic shock 8 months after the end of chemotherapy.


RESULTS
The patient was initially treated with intra-aortic balloon pumping, followed by conversion to left ventricular assist device with an Abiomed AB5000 (Abiomed, Inc, Danvers, MA) and right ventricular assist device with a centrifugal pump and a membrane oxygenator, in addition to tricuspid annuloplasty, due to rapid deterioration to cardiogenic shock. With intensive medical treatments during biventricular support, her cardiac and respiratory functions gradually improved, although moderate mitral regurgitation persisted despite of left ventricular unloading. At 64 days of biventricular support, she underwent mitral valve annuloplasty to correct regurgitation under cardiopulmonary bypass. She was consequently weaned from biventricular assist successfully 8 days after mitral surgery (72 days of biventricular support). The patient discharged uneventfully from our hospital and survives at home 12 months after weaning from the ventricular assist devices.


CONCLUSION
Our case and the literature review highlight potential usefulness of aggressive mechanical biventricular support for cardiac recovery in patients with anthracycline-induced cardiomyopathy. Additional valve surgery and neurohormonal medications may be also promising in such patients with cancer, who are contraindicated for heart transplantation.
['Takami|Yoshiyuki|Y|', 'Hoshino|Naoki|N|', 'Kato|Yasuchika|Y|', 'Sakurai|Yusuke|Y|', 'Amano|Kentaro|K|', 'Higuchi|Yoshiro|Y|', 'Tochii|Masato|M|', 'Ishida|Michiko|M|', 'Ishikawa|Hiroshi|H|', 'Takagi|Yasushi|Y|', 'Ozaki|Yukio|Y|']
D000328:Adult D018943:Anthracyclines D000970:Antineoplastic Agents D001021:Aortic Valve D009202:Cardiomyopathies D002315:Cardiopulmonary Bypass D005260:Female D016027:Heart Transplantation D006352:Heart Ventricles D006353:Heart-Assist Devices D006801:Humans D007423:Intra-Aortic Balloon Pumping D016403:Lymphoma, Large B-Cell, Diffuse D012770:Shock, Cardiogenic D016896:Treatment Outcome
recovery cardiomyopathy Anthracycline biventricular assist device