Pospartum cardiomyopathy

Abstract

Patient of 26 years with heart failure in Functional Class IV (NYHA) due to post-partum cardiomyopathy was hospitalized as an emergency due to a marked worsening of his clinical picture. At admission, the echocardiography revealed biventricular dysfunction with an ejection fraction of 20%. There was no response to intravenous drug therapy or use of the intra-aortic balloon pumping. Therefore, it was decided to extend cardiocirculatory support with the use of veno-arterial ECMO through femoral approach. Considering that the patient had clinical conditions for the transplant, it was decided by biventricular mechanical assistance with centrifugal pump being the blood drainage through the ventricles and infusion by the pulmonary trunk and aorta. The lymphocyte panel revealed 98% lymphocytic reactivity, so she received three plasmapheresis sessions, being a before and two after the heart transplant. The patient developed stable hemodynamic conditions without mechanical assistance. However, the she developed uncontrollable mediastinitis and sepse and died on the 75th postoperative day. Despite the undesirable outcome, the present case deserves discussion about the tactics adopted in the management of terminal heart failure.