A Case of Peripartum Cardiomyopathy: Anesthetic Management of Patients on Mechanical Circulatory Support and Status Post Heart Transplantation

Abstract

We present the case of a 28-year-old woman who was diagnosed with peripartum cardiomyopathy in the weeks following a normal vaginal delivery. This patient required support with a TandemHeart percutaneous ventricular assist device for refractory cardiogenic shock, followed by a durable ventricular assist device, and ultimately a heart transplant. We use this patient’s case to discuss the physiologic changes in the cardiovascular system during pregnancy and also the effect of pregnancy on preexisting cardiac conditions. We discuss the distinguishing characteristics of peripartum cardiomyopathy and suggest workup and both medical and mechanical therapeutic strategies (including extracorporeal membrane oxygenation, intra-aortic balloon pump, and ventricular assist devices). Finally, we review anesthetic implications for patients with ventricular assist device or who are status post heart transplant who undergo noncardiac surgery.