A Case of Peripartum Cardiomyopathy Affected by Left Ventricle Thrombus

Abstract

Peripartum cardiomyopathy (PPCM) mimicking dilated cardiomyopathy is defined as an idiopathic cardiomyopathy affecting perinatal or postnatal women with no cardiac history. It occurs in 1 in 20,000 births in Japan. A 25-year-old female without cardiology diseases presented to our hospital's emergency department with upper abdominal pain, exertional dyspnea, and leg edema. One month prior, she gave birth to her first child via vaginal delivery. At 36 weeks of gestation, she was diagnosed with pregnancy hypertension by an obstetrician. Ultrasonography and non-contrast computed tomography were performed and revealed an edematous gallbladder as well as dilated hepatic and inferior jugular veins. Chest X-ray revealed cardiomegaly, lung edema, and pleural effusion. She was diagnosed with congestive heart failure. Transthoracic echocardiogram (TTE) revealed a dilated left ventricle with a reduced ejection fraction (EF) of 17%. Immediately after admission, diuretic agents, including furosemide and carperitide, were administered. Although her heart failure improved with sufficient diuretic treatment, thromboses measuring 16 × 8 and 29 × 11 mm in her left ventricle were revealed by TTE on day 10. Heparin sodium and warfarin potassium were initiated, which reduced the thromboses. Her symptoms improved, although EF was not restored to normal function. She was discharged on day 40 and an outpatient clinic follow-up was scheduled. Long-term prognosis of PPCM is currently unknown, and meticulous follow-up of the patient is required. Here we present a case of PPCM that was affected by a left ventricular thrombus.