A 47-year-old woman was transferred to our hospital after experiencing cardiogenic shock and undergoing intra-aortic balloon pumping. The patient had received the first dose of the messenger RNA (mRNA)-1273 vaccine (Moderna) before hospitalization. Echocardiography revealed a reduced left ventricular ejection fraction and massive biventricular thrombi. Cardiac magnetic resonance imaging suggested myocarditis. After the ventricular thrombus was resolved, an endomyocardial biopsy confirmed the diagnosis of myocarditis. Finally, we terminated the intravenous inotrope therapy. Although fulminant myocarditis with biventricular thrombi after mRNA vaccination for coronavirus disease 2019 is extremely rare, post-vaccination myocarditis should be considered in the differential diagnosis of a cardiogenic shock.

　In 1978, we reported a case of severe primary pulmonary hypertension (PH) in a 14-year-old girl. Initial cardiac catheterization revealed severe PH and pulmonary arterial pressure (Ppa) of 145/65 (100) mmHg. Twenty-four-hour monitoring revealed a decrease in Ppa with administration of supplemental oxygen and alpha-blockade. After that, she was treated with vasodilating drugs including alpha-blockade and home oxygen therapy. She survived for 45 years with only mild exertional dyspnea, except during her last few years. At 1 month before death, her Ppa was 160/44 (82). A chest X-ray revealed almost the same cardiac configuration as that observed on her initial visit. This is the longest survival seen in a patient with idiopathic pulmonary arterial hypertension and an extremely high Ppa.