Giant cell myocarditis: challenge of mechanical circulatory support (RCD code: III-1B.1.o)

We report the case of a young adult male who presented with acute fulminant myocarditis, deteriorated rapidly despite intra‑aortic balloon pump and inotropic support, and received a HeartMate II continuous flow left ventricular assist device (LVAD) as a bridge to heart transplantation. The left ventricular apical core biopsy showed giant cell myocarditis. Despite treatment with steroids and immunosuppression, there was progressive left and right ventricular dysfunction, culminating in asystole and a Fontan‑like circulation dependent on LVAD flow. He developed severe right heart failure with ascites and pleural effusions, refractory to pharmacological therapy, and ultimately died due to complications of renal failure. We review the diagnosis, natural history and management of giant cell myocarditis, with a focus on challenges raised by mechanical circulatory support in this patient group. JRCD 2013; 1 (3): 23–26