Postpartum Left Ventricular Dysfunction in Preeclampsia With Incidental Patent Ductus Arteriosus: A Multimodality Hemodynamic Assessment

Hypertensive disorders of pregnancy, particularly preeclampsia, are associated with increased risk of postpartum cardiovascular complications. We report a case of a 43-year-old female with known mild-to-moderate aortic regurgitation and thoracic aortic dilation who developed new left ventricular systolic dysfunction shortly after cesarean delivery for severe preeclampsia. On postoperative day three, she presented with chest pain and was found to have a reduced left ventricular ejection fraction (43%) on transthoracic echocardiography. Computed tomography angiography excluded aortic dissection but revealed a patent ductus arteriosus not previously described on earlier imaging, raising concern for possible shunt-mediated volume overload. Cardiac magnetic resonance imaging performed four months postpartum demonstrated low-normal systolic function with Qp/Qs of 0.76, and right heart catheterization at seven months confirmed Qp/Qs of 1 with normal pulmonary vascular resistance, indicating no hemodynamically significant shunt. The patient was managed with guideline-directed medical therapy for heart failure and remained clinically stable with recovery of ventricular function. This case highlights the importance of multimodality imaging and invasive hemodynamic assessment before pursuing structural intervention in postpartum patients with newly identified cardiac abnormalities.