Successful treatment of acute myocarditis with right and left ventricular assist devices complicated by heparin-induced thrombocytopenia

Myocarditis is defined as an inflammatory disease of the heart muscle, diagnosed by established histological, immunological, and immunohistochemical criteria (1). It is commonly developed by virus, but also can be a result of bacterial infection or various toxins (2–4). The exact incidence is unknown, however, in number of routine autopsies, 1–9 % of all patients had signs of myocardial inflammation. In young adults, almost 20 % of all cases of sudden death are due to myocarditis (5). In symptomatic patients, myocarditis often presents as acute heart failure, although it can mimic acute myocardial infarction or a tachyarrhythmia (6). The use of Intravenous Immunoglobulin in the treatment of acute myocarditis is controversial (7, 8). High dose of steroids have been used in certain types of myocarditis, although the treatment regimen is not defined (9–11). In severe cases patients develop cardiogenic shock and require mechanical circulatory support or heart transplantation (4). Here we present a case of acute myocarditis managed with left and right ventricular assist devices and good outcome despite of postoperatively developed heparin induced thrombocytopenia.