Mitral chordal rupture by Impella 5.0 in a patient with fulminant myocarditis and inflammation of mitral chordae

A 26-year-old man was admitted with new-onset acute heart failure. Echocardiography showed severe biventricular systolic dysfunction with trivial mitral regurgitation (MR). Right ventricular endomyocardial biopsy showed heavy inflammatory cellular infiltrate dominated by lymphocytes (Panel A, scale bar: 100 μm). He was diagnosed with lymphocytic fulminant myocarditis. Due to cardiogenic shock with multiple organ failure, Impella 2.5 and veno-arterial peripheral extracorporeal membrane oxygenation (VA ECMO) were immediately initiated. The haemodynamic profile improved. However, cardiac function did not improve enough to withdraw the mechanical support. Therefore, we exchanged Impella 2.5 for Impella 5.0 after 7 days, for long-term mechanical support. Echocardiography showed trivial MR after 8 days from...