Fulminant recurrent myocarditis complicated by papillary muscle rupture and cardiogenic shock managed with ExtraCorporeal membrane oxygenation and impella support

We present a case of acute-on-recurrent viral myocarditis complicated by papillary muscle rupture of the mitral valve. This rare clinical scenario, combining refractory cardiogenic shock with acute severe mitral valve regurgitation, illustrates the therapeutic challenges associated with temporary mechanical circulatory support (tMCS). Although mitral valve replacement would theoretically correct the mechanical complication, cardiac surgery in the setting of profound cardiogenic and septic shock carries a high risk of failure. In this context, the combination of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with left ventricular unloading using a micro-axial pump (Impella 5.5, Abiomed, USA) appeared to us to be the most appropriate strategy, offering time for stabilisation before surgical intervention. Despite intensive support and targeted immunomodulatory treatment, the patient presented with severe neurological injury, ultimately leading to withdrawal of life-sustaining therapies.