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OBJECTIVE:
Early diagnosis & management of Peripartum Cardiomyopathy
(PPCM), a rare idiopathic form of nonischemic CM, prevents major adverse events e.g. prolonged mechanical circulatory support, cardiac transplantation, or death (30%). We report the use of temporary biventricular mechanical assistance (BIVAD) alongwith with extracorporeal membrane oxygenation (ECMO) as bridge to recovery for this fatal condition. This combined strategy for PPCM is never reported.
METHODS & RESULTS:
32-year-old female Gravida 3, developed dyspnea on 5^th day after delivering twins via c-section at 37 weeks gestation for prolonged
tocolysis. She had pre-eclamplsia & mild peri-partum pulmonary edema
earlier.(Fig 1A) She was readmitted with pulmonary edema,LVEDP of 50 & PCWP >35.(Fig 1B) TEE revealed moderate RV & severe LV dysfunction with EF 10%. She continued to decompensate, requiring intubation and inotropic support. When the use of an IABP failed to stabilize the patient, the decision was made to place her on BIVAD and ECMO. The circuit consisted of two CentriMag centrifugal pumps and a Quadrox D membrane oxygenator in RVAD circuits (figure 1C). On day 5, the patient met the weaning criteria and was successfully removed from BIVAD & ECMO.(Figure 1D) Her LV EF improved to 55% and she was discharged on 11^th day on Carveilol, ACE inhibitors , Coumadin and
Bromocriptine.
CONCLUSIONS:
The demographics ( multiparity, obesity, hypertension,smoking) and pregnancy related risk factors(twin pregnancy, pre-eclampsia,prolonged tocolysis) predisposed her to PPCM. A high index of suspicion, along
with early echocardiographic confirmation of biventricular systolic
dysfunction, led to timely intervention with BIVAD and ECMO and excellent outcome in this case.