Acute left and right ventricular heart failure with transient myocardial edema in a 26-year-old female patient with peripartum cardiomyopathy and clivus chordoma

Abstract

Peripartum cardiomyopathy (PPCM) is a life-threatening disease characterized by the clinical symptoms of acute heart failure with reduced ejection fraction in women at the end of their pregnancy or in the first months after delivery. A 26-year-old woman was delivered by cesarean section at 29 weeks due to increasing intracranial pressure from a newly diagnosed clivus chordoma. She was transferred to ICU after septic deterioration, presenting with hemodynamic instability, tachycardia, high catecholamine support, oxygen needs, and signs of cardiac decompensation. We found a significant impairment of the left and as well as the right ventricular function (LVEF 30–35%, FAC 30%) combined with pericardial effusion and a septal myocardial edema (cardiac MRI). There were no signs of myocardial inflammation and no hint for a Takotsubo cardiomyopathy neither but in total pointing to a PPCM. Left and right cardiac function improved stepwise after breastfeeding was stopped and bromocriptine was started, supporting our theory that the patient suffered from a peripartum cardiomyopathy involving both ventricles. Although right ventricular function was also reduced, which is a marker of a severe process, cardiac function improved quickly. This case shows that even in complex intensive care cases in postpartum patients, a cardiac genesis of the hemodynamic deterioration should always be considered and clarified to be able to provide these patients with adequate therapy and regulate the cardiac course of PPCM.