An Interesting Case of Peripartum Cardiomyopathy With Biventricular Thrombi

Abstract

Peripartum cardiomyopathy (PPCM) is a cause of heart failure that develops within five months postpartum. Biventricular thrombosis is a rare complication of PPCM with only a few cases reported in the literature. Here, we report a case of PPCM with biventricular thrombosis that was successfully treated with medical management.

Multiple biventricular intracardiac thrombi an unusual finding in peripartum cardiomyopathy: A case report

“…To date, only 11 cases have been reported (Table 1). In these reports, the age at presentation ranged between 19 and 39 years [1,12], only ve cases documented the parity at presentation which was between 2 and 7 [3,4,[13][14][15], and the onset of heart failure symptoms varied from 2 weeks to 5 months [3,16]. In the index case, our patient was in her early 40s, she was quite older compared to patients in previous cases, her gravidity was 6 and the manifestations of heart failure symptoms began 5 months post-delivery similar to existing cases.…”

“…As per the heart failure guidelines for peripartum cardiomyopathy, anticoagulation therapy should be continued until left ventricular function normalizes [2], that's within 2 to 6 months in 23 to 72% of cases, but it can take longer up to 5 years [20]. In previous cases of biventricular thrombi, 5 patients had clot resolution within 3 weeks [4,11,13,16], except a single patient who had clot resolution after 3 months [15], and other 5 cases lacked data on clot resolution [1,3,12,14,17,18]. Similarly, the time to clot resolution in our case was 2 weeks.…”

“…It is characterized by left ventricular dysfunction and dilatation, however, its cause remains unknown [2]. Its incidence is 1 per 3000 to 1 per 4000 live births [2,3]. The incidence of peripartum cardiomyopathy has displayed geographical variability whereby some places like Japan have the lowest of 1 in 20,000 live births, In USA it is 1 in 4000 and the highest in Nigeria 1 in 100 live births with a fatality rate of between 20-50% [3,4].…”

“…Descriptive summary of case reports(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) describing biventricular intracardiac thrombi in patients with PPCM…”