Left ventricular assist device as a bridge to recovery in a young woman admitted with peripartum cardiomyopathy

Abstract

Left ventricular assist device as a bridge to recovery in a young woman admitted with peripartum cardiomyopathy Left ventricular assist devices (LVAD) are an effective therapeutic option for end-stage heart failure patients as a bridge to cardiac transplantation in those who deteriorate despite maximal therapy and when a donor heart is not ready available. In some patients, cardiac recovery has been reported while supported by an LVAD. In this case report, we describe a 29-year-old female who was admitted to our centre because of peripartum cardiomyopathy (PPCM). Despite intensive treatment with intravenous inotropes and intra-aortic balloon counterpulsation she had a persisting low cardiac index and an LVAD was implanted. In the months following implantation the left ventricular systolic function improved and the left ventricular dimensions normalised. Eventually the LVAD could be explanted nine months after implantation. At this moment, three years after explantation, echocardiography shows a normal-sized left ventricle and almost completely recovered systolic function. (Neth Heart J 2008;16:426-8).

Mechanical Circulatory Support for Peripartum Cardiomyopathy

“…The mechanism is related to multiple factors such as unloading, neurohormonal inhibition and the causation of myocardial injury [8]. Another case report has been published involving a postpartum cardiomyopathy requiring LVAD support in which the LVAD was explanted 9 months after implantation and complete recovery of ventricular function was demonstrated 3 years later [9].…”

Interest of Ventricular Assist Device in Peripartum Cardiomyopathy, a Case Report and Review Article*

“…In cases where LVAD acts as bridge to recovery, it will help maintaining the patient alive, allowing the myocardium to recover. Recovery of the left ventricle function in this case is due mainly to recovery of the underlying disease, nevertheless there is now compelling evidence, that near complete unloading of the left ventricle with the use of a left ventricular assist device is associated with structural reverse remodeling that can be accompanied by functional improvement [18][19][20][21][22][23]. Sufficient recovery of left ventricular function, allowing LVAD explantation, however, is rare and is mainly feasible in patients suffering from acute myocarditis or post partum cardiomyopathy (PPM) [18].…”

“…Recovery of the left ventricle function in this case is due mainly to recovery of the underlying disease, nevertheless there is now compelling evidence, that near complete unloading of the left ventricle with the use of a left ventricular assist device is associated with structural reverse remodeling that can be accompanied by functional improvement [18][19][20][21][22][23]. Sufficient recovery of left ventricular function, allowing LVAD explantation, however, is rare and is mainly feasible in patients suffering from acute myocarditis or post partum cardiomyopathy (PPM) [18]. Explantation in this case can be considered if the following criteria are met while the left ventricular assist device is off for 15 minutes: 1-Echocardiographic criteria [18,23]: a left ventricular end diastolic diameter of less than 60 mm, a left ventricular end-systolic diameter of less than 50 mm, a left ventricular ejection fraction (LVEF) of more than 45%, No or maximum grade II mitral and/or aortic valve regurgitation, No RV dilation (RVOT diameter < 35 mm, short-/long-axis ratio < 0.6), and No or maximum grade II tricuspid or pulmonary valve regurgitation.…”

“…Sufficient recovery of left ventricular function, allowing LVAD explantation, however, is rare and is mainly feasible in patients suffering from acute myocarditis or post partum cardiomyopathy (PPM) [18]. Explantation in this case can be considered if the following criteria are met while the left ventricular assist device is off for 15 minutes: 1-Echocardiographic criteria [18,23]: a left ventricular end diastolic diameter of less than 60 mm, a left ventricular end-systolic diameter of less than 50 mm, a left ventricular ejection fraction (LVEF) of more than 45%, No or maximum grade II mitral and/or aortic valve regurgitation, No RV dilation (RVOT diameter < 35 mm, short-/long-axis ratio < 0.6), and No or maximum grade II tricuspid or pulmonary valve regurgitation. 2-Catheterization criteria: left ventricular end-diastolic pressure (or pulmonary-capillary wedge pressure) of less than 12 mm Hg and Cardiac index > 2.6 L/min/m 2 .…”

Expected and unexpected cardiac problems during pregnancy

“…The case reports of peripartum cardiomyopathy and coronary artery dissection in this issue illustrate that life-threatening heart disease can also develop as a new disease related to pregnancy. [2][3][4] In the reported cases the events occurred a few weeks before delivery or within days to weeks post-partum, but presentation several months after delivery is not uncommon. New cardiac disease can also coincide with pregnancy by chance as in the case report of a woman with third-degree AV block.…”