Acute left and right ventricular Heart Failure with Transient Myocardial Edema in a 26-Year-Old Female patient with Peripartum Cardiomyopathy and Clivus Chordoma

Purpose: Peripartum cardiomyopathy (PPCM) is a life-threatening disease characterized by the clinical symptoms of acute heart failure with reduced ejection fraction in women at the end of their pregnancy or in the first months after delivery. Methods: A 26-year-old woman was delivered by cesarean section at 29 weeks due to increasing intracranial pressure from a newly diagnosed clivus chordoma. She was transferred to ICU after septic deterioration, presenting with hemodynamic instability, tachycardia, high catecholamine support, oxygen needs, and signs of cardiac decompensation. Results: We found a significant impairment of the left and as well as the right ventricular function (LVEF 30-35%, FAC 30%) combined with pericardial effusion and a septal myocardial edema (cardiac MRI). There were no signs of myocardial inflammation and no hint for a Takotsubo cardiomyopathy neither but in total pointing to a PPCM. Left and right cardiac function improved stepwise after breastfeeding was stopped and bromocriptine was started, supporting our theory that the patient suffered from a peripartum cardiomyopathy involving both ventricles. Although right ventricular function was also reduced, which is a marker of a severe process, cardiac function improved quickly. Conclusion: This case shows that even in complex intensive care cases in postpartum patients, a cardiac genesis of the hemodynamic deterioration should always be considered and clarified to be able to provide these patients with adequate therapy and regulate the cardiac course of PPCM.