Left ventricular free wall rupture in acute fulminant myocarditis during long-term cardiopulmonary support

A 77-year-old woman with acute myocarditis developed cardiogenic shock soon after admission and was given mechanical cardiopulmonary support. Echocard iography revealed severe global left ventricular hypokinesia. After 5 days of mechanical support, left ventricular wall motion gradually began to impr ove, but the patient died of cardiac tamponade on day 13. At necropsy, a fr ee wall rupture was found where the apical akinetic area bordered the basal portion, an area which had shown better wall motion. Left ventricular free wall rupture in acute myocarditis has not been reported, hut this case ind icates that it may occur in fulminant myocarditis when a cardiopulmonary su pport system is used.