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Rapid resolution of peripartum cardiomyopathy with a minimally invasive ventricular assist device after Cesarean delivery
Abstract Number: T-16
Abstract Type: Case Report/Case Series
Peripartum cardiomyopathy (PPCM) is a rare form of heart failure with broad anesthetic and post-surgical implications. The incidence of PPCM is 1 in 3000-4000 births (1). The presentation of PPMC varies in onset, as it can occur between the last month of pregnancy or up to 5 months after delivery. Its etiology is nonspecific, as causes include viral, autoimmune and idiopathic mediated cardiomyopathy (2). We present a case of PPMC occurring immediately after cesarean delivery requiring emergent placement of an ImpellaTM (Abiomed, Danvers, MA) percutaneous ventricular assist device with successful recovery of cardiac function and removal of the assist device.
A 34 year-old gravida 5, parity 3 female at gestational age of 39 weeks + 3 days was admitted for an elective cesarean section due to a failed external cephalic version. Toward the conclusion of the case the patient complained of chest tightness and was noted to be hypotensive (SBP 70-80’s). The patient was noted to have pink frothy secretions with a decrease in oxygenation saturation levels. She was emergently intubated and an emergent transesophageal echocardiogram was performed which showed an ejection fraction of 10% with global hypokinesis. The decision was made to provide circulatory support with an ImpellaTM assist device via a percutaneous approach through her femoral artery. The patient’s cardiac function improved gradually, and the ImpellaTM was removed 4 days after implantation.
The diagnosis of PPCM entails the following clinical and objective data: development of heart failure with the absence of a determined etiology in the last month of pregnancy or within the first 5 postpartum months and an ejection fraction less than 45%. With mechanical assist device’s becoming more common, their role in patients with PPCM is paramount. The Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) analyzed a total of 99 women with PPCM between 2006-2012. Overall, it was found that patients with PPCM receiving mechanical assist device’s had an improved survival rate compared to women with non-PPCM cardiomyopathy receiving assist devices (P=0.01) (3). The ImpellaTM may represent an ideal assist device in patients with PPCM since patients with non-ischemic cardiomyopathy have a faster rate of recovery and this device was approved for shorter periods of use. Our case highlights the need for further research in this area and potentially foreshadows the critical role of minimally invasive LVAD’s in patients with PPCM.
1.Chestnut, David. (2004). Chestnut's Obstetric Anesthesia: Principles and Practice. Philadelphia, PA: Mosby.
2.Heider AL, Kuller JA, Strauss RA, Wells SR. Peripartum cardiomyopathy: A review of the literature. Obstet Gynecol Surv 1999;54:526-31
3.Renzo Y et al. Outcomes of Patients With Peripartum Cardiomyopathy Who Received Mechanical Circulatory Support. Circulation: Heart Failure. 2014;7:300-309