SCIENTIFIC JOURNAL of the Hungarian Society of Cardiology

The role of optimal medical and device therapy in the complex treatment of peripartum cardiomyopathy

█ Case Report

DOI: 10.26430/CHUNGARICA.2023.53.4.386

Authors:
Bánfi-Bacsárdi Fanni1, 2, Muk Balázs1, 2, Polgár Balázs1,
Török Gábor Márton1, Duray Gábor Zoltán1, Kiss Róbert Gábor1
1Észak-pesti Centrumkórház – Honvédkórház, Kardiológiai Osztály, Budapest
2Gottsegen György Országos Kardiovaszkuláris Intézet, Felnőtt Kardiológiai Osztály, Budapest
Levelezési cím
Dr. Bánfi-Bacsárdi Fanni, Gottsegen György Országos Kardiovaszkuláris Intézet,
Felnőtt Kardiológiai Osztály; 1096 Budapest, Haller utca 29. E-mail cím: bacsardifanni@gmail.com

Summary

Background: The optimized, individualized therapy of peripartum cardiomyopathy (PPCM) is crucial in reducing mortality and morbidity.
Case: We report the case of a 39-year-old female who was admitted to our hospital with acutely decompensated de novo heart failure with reduced ejection fraction (HFrEF) as a 35-week gravida (NTproBNP: 5680 pg/ml, NYHA IV). Transthoracic echocardiography (TTE) at admission showed dilated (LVEDD: 66mm), diffusely hypokinetic left ventricle and severely abnormal LVEF (25%). Considering severe, decompensated PPCM, the multidisciplinary team indicated urgent caesarean section. Bromocriptine, anticoagulation and direct vasodilator therapy were started. With complex anticongestive therapy, and combined neurohormonal antagonist therapy (ACEI+βB+MRA) of HFrEF with addition of an SGLT2i, euvolemia and hemodynamic stability were reachable and maintainable. Cardiac MR verified severely impaired left ventricular function (LVEF: 22%, LVEDV: 191 ml), coronary CT angiography justified intact coronary arteries. After discharge in NYHA II functional class, she was followed-up at our Heart Failure Outpatient Clinic. Severe left ventricle dysfunction persisted after >6 months despite optimized medical therapy (LVEF: 25%, NYHA II), thus a primary prevention CRT-D was implanted (considering LBBB, QRS:140msec). After CRT-D implantation, TTE registered normal left ventricle dimensions (LVEDD: 52 mm) and LVEF (56%). At 20-month FUP, she is in a good clinical condition (NTproBNP: 203 pg/ml, NYHA I).
Conclusion: Even though PPCM often shows full recovery, in case of persisting HFrEF evaluating the need of device therapy after >6 months of guideline-directed pharmacotherapy is crucial.

ISSUE: CARDIOLOGIA HUNGARICA | 2023 | VOLUME 53, ISSUE 4

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