Abstract
We report two cases of patients with dilated cardiomyopathy （DCM） who were successfully treated for severe heart failure by plasma exchange （PE）.
Case 1 was a 1-year-old girl who was treated using mechanical ventilation and infusions of catecholamine and diuretics for severe heart failure. Although her cardiac function improved with catecholamine infusion, this was catecholamine-dependent and the dosage could not be reduced. As an alternative therapy, PE was performed on the 99th hospital day. Cardiac function gradually improved after PE, and catecholamine infusion was discontinued with additional administration of pimobendan and denopamine. In addition, the carvedilol dosage was increased.
Case 2 was a 1-year-old girl who was treated with infusions of catecholamine and diuretics for intractable heart failure. Cardiac function marginally improved with the maximum dose of catecholamine. Based on our experience with case 1, we performed an earlier initiation of PE, on the 41st hospital day before a reduction in the catecholamine dose. After PE, cardiac function gradually improved and catecholamine infusion could be discontinued. The carvedilol dosage was also increased.
In both cases, clinical symptoms improved from NYHA class IV to II, and they were discharged without significant sequelae on the 210th and 137th hospital days, respectively.
Infantile DCM is a life threatening condition with poor prognosis, and often requires heart transplantation as an ultimate therapy. Under difficult circumstances related to heart transplantation in Japan, PE could be considered a potential rescue therapy in patients with intractable heart failure not stabilized by medical therapy alone.
