Abstract 4145402: The Role of Extracorporeal Membrane Oxygenation in Advanced Peripartum Cardiomyopathy Requiring Heart Transplant: A Case Report

INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a form of systolic heart failure, which occurs late in pregnancy or within the first 5 months postpartum and it is the most common cause of death related to heart failure in pregnant women. To establish the diagnosis, other causes of heart failure must be ruled out and a left ventricular ejection fraction (LVEF) <45% must be present. Prognosis can range from complete recovery of the heart function to progressive deterioration with the need for mechanical circulatory support and heart transplant. DESCRIPTION OF CASE: We present the case of a 33-year-old woman with a 5-year history of PPCM. She was enrolled in the heart transplant program for progressive deterioration of cardiac function with an LVEF of 31%. The patient was admitted to the emergency department due to progressive dyspnoea and signs of low cardiac output and treatment for decompensated heart failure was established. Initially, she remained stable, however, on the fifth day of hospitalization the patient presented an event of monomorphic ventricular tachycardia and sudden hemodynamic deterioration. The diagnosis of cardiogenic shock was established, which was refractory to medical treatment, therefore an intra-aortic balloon pump was implanted and an extracorporeal membrane oxygenation (ECMO) system with veno-arterial configuration was placed. After 4 days of ECMO assistance, the patient showed hemodynamic improvement, therefore vasopressor and inotropic support were gradually reduced and she was weaned off mechanical support. Afterwards, given the availability of an organ, a bicaval orthotopic heart transplant was performed without complications. DISCUSSION: Recovery rates of PPCM are typically high, however, there is an important percentage of patients who progress to cardiogenic shock with a mortality rate up to 50%. This highlights the importance of recognition and adequate treatment of PPCM and the early use of mechanical circulatory support if required as a bridge to recovery or heart transplantation.