Predelivery extracorporeal membrane oxygenation in a life-threatening peripartum cardiomyopathy: save both mother and child

Peripartum cardiomyopathy (PPCM) refers to the development of heart failure (HF) in the last month before or within 5 months after delivery in the absence of preexisting heart disease. In critically ill PPCM patients unresponsive to medical therapy, extracorporeal membrane oxygenation (ECMO) may be considered even before delivery as a bridge to recovery or as a bridge to heavier mechanical support. We describe the case of a 29 year-old White patient admitted for severe HF developed during the last month of pregnancy. Profound left ventricular systolic dysfunction was consistent with PPCM. Predelivery peripheral venoarterial ECMO was implanted as circulatory mechanical support allowing for a successful fetal extraction by Cesarean-section (C-section). The patient underwent left ventricular assistance device implantation at day 21, as she did not recover. Mother and child are doing well at 3-month follow-up. Predelivery ECMO is therefore a valuable option in severe cases of HF complicating PPCM during late pregnancy.