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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.<\/jats:p>","DOI":"10.1136\/bcr-2025-271792","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:30:26Z","timestamp":1777041026000},"page":"e271792","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Fulminant recurrent myocarditis complicated by papillary muscle rupture and cardiogenic shock managed with ExtraCorporeal membrane oxygenation and impella support"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1139-8798","authenticated-orcid":false,"given":"Quentin","family":"Lajoye","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Anaesthesia and Critical Care, CHU Bordeaux, Bordeaux, Pessac, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3708-4653","authenticated-orcid":false,"given":"Antoine","family":"Beurton","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Anaesthesia and Critical Care, CHU Bordeaux, Bordeaux, Pessac, France"},{"name":"Biologie des Maladies Cardiovasculaires, U1034, Universit\u00e9 de Bordeaux, INSERM U1034, Pessac, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran\u00e7ois-Xavier","family":"H\u00e9rion","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Anaesthesia and Critical Care, CHU Bordeaux, Bordeaux, Pessac, France"},{"name":"Biologie des Maladies Cardiovasculaires, U1034, Universit\u00e9 de Bordeaux, INSERM U1034, Pessac, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Oddos","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Anaesthesia and Critical Care, CHU Bordeaux, Bordeaux, Pessac, France"},{"name":"Biologie des Maladies Cardiovasculaires, U1034, Universit\u00e9 de Bordeaux, INSERM U1034, Pessac, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julien","family":"Imbault","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Anaesthesia and Critical Care, CHU Bordeaux, Bordeaux, Pessac, France"},{"name":"Biologie des Maladies Cardiovasculaires, U1034, Universit\u00e9 de Bordeaux, INSERM U1034, Pessac, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre","family":"Ouattara","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Anaesthesia and Critical Care, CHU Bordeaux, Bordeaux, Pessac, France"},{"name":"Biologie des Maladies Cardiovasculaires, U1034, Universit\u00e9 de Bordeaux, INSERM U1034, Pessac, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"2026042407302160000_19.4.e271792.1","unstructured":"Clinical presentation and outcome in a contemporary cohort of patients with acute myocarditis: multicenter lombardy registry. 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