Resolution of giant cell myocarditis after extended ventricular assistance

Lower recurrence rates and improved long-term outcomes are the goal of treatment for giant cell myocarditis (GCM). We describe a case of GCM in an Asian woman who presented with new onset palpitations and syncope. She initially had normal systolic function by echocardiography with magnetic resonance imaging evidence of infiltrative cardiomyopathy. She underwent implantation of a biventricular assist device (BiVAD) because of rapidly deteriorating hemodynamic status. Giant cell myocarditis was diagnosed at that time by surgical biopsy. She was not treated with immunosuppressive therapy because of low likelihood of recovery and concerns for potential infection with the BiVAD in place. She received a heart transplant 12 months later and had extensive fibrosis but no evidence of active GCM in the heart explant. The role of extended BiVAD support in patients with GCM should be further investigated. (Arch Pathol Lab Med. 2009;133:138-141).