Surgical Decannulation of LVAD-ECMO System After Cardiogenic Shock

Peripartum cardiomyopathy is a disease that can lead to death. Peripartum cardiomyopathy (PPCM) is a rare, often dilated, cardiomyopathy with systolic dysfunction that presents in late pregnancy or, more commonly, the early postpartum period. Women with PPCM typically present with symptoms of congestion, including dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and edema of the lower extremities. Less commonly, women present with cardiogenic shock that requires inotropic or mechanical circulatory support. Uncommon presentations include symptomatic or even unstable arrhythmias (1). The incidence of PPCM in the United States ranges from approximately 1 in 1000 to 4000 live births. Association conditons like age, race (in the USA, notably higher in black woman) (2), preeclampsia, hypertension, and other associated conditions have been reported but are less substantiated, including substance abuse, anemia, asthma, prolonged tocolysis, diabetes mellitus, obesity, and malnutrition.

The author reports the case of a 28-year-old woman who started with heart failure three months after delivery. One year later, she was admitted to the authors’ institution with acute pulmonary edema that was treated at ICU. On the second day at ICU, she again had acute pulmonary edema. The authors decided on an IABP implant, which was not effective, and hours later implanted an ECMO-LVAD system with left ventricular drainage (LVAD) and ECMO venous cannula through the femoral vein, joining the Y drainage and returning flow (Outflow) by the aorta. Sternotomy was performed initially due to bridge to transplant, which later proved to bridge to recovery.

References

1. Puri A, Sethi R, Singh B, Dwivedi SK, Narain VS, Saran RK, et al. Peripartum cardiomyopathy presenting with ventricular tachycardia: a rare presentation. Indian Pacing Electrophysiol J. 2009;9(3):186-189.
2. Mielniczuk LM, Williams K, Davis DR, Tang AS, Lemery R, Green MS, et al. Frequency of peripartum cardiomyopathy. Am J Cardiol. 2006; 97:1765–1768.

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