COVID-19-related myocarditis post-heart transplantation

•This report describes the first heart transplantation case of biventricular failure due to myocarditis late post-COVID-19.•Myocarditis can occur in the long term post-COVID-19.•In post-COVID patients with biventricular failure, exclude myocarditis as a cause.•Cardiovascular magnetic resonance imaging can help exclude myocarditis in patients with heart failure. This report describes the first heart transplantation recipient with acute biventricular heart failure symptoms caused by a post-myocarditis state, late after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. No other viral pathogens could be detected. Computed tomography angiography did not show cardiac allograft vasculopathy, and myocardial biopsy demonstrated no clinically relevant rejection. Subsequent cardiovascular magnetic resonance imaging revealed extensive epicardial delayed enhancement without myocardial edema. Heart failure medication was initiated and an implantable cardioverter defibrillator was implanted (due to non-sustained ventricular tachycardias), leading to a partial recovery of the ejection fraction. Further studies are needed to investigate the number of heart transplant recipients with myocardial damage after a SARS-CoV-2 infection.