Sacubitril/valsartan facilitates recovery of cardiac function in a patient with peripartum cardiomyopathy: A case report

Background Peripartum cardiomyopathy (PPCM) is a rare but life-threatening form of heart failure that typically occurs in late pregnancy or early postpartum. Management of PPCM may be challenging due to hypotension and the unfavorable effect of medication on fetus. Case summary A 26-year-old woman with a twin pregnancy was referred at 10 weeks of gestation for evaluation of premature ventricular contractions. Echocardiography revealed left ventricular ejection fraction (LVEF) of 70%, and NT-proBNP level was 75 pg/mL on blood testing. She was hospitalized at 30 weeks of gestation for threatened preterm labor and diagnosed as pre-eclampsia. At that time, LVEF decreased to 40%, and NT-proBNP level increased to 4359 pg/mL, prompting an urgent cesarean section. After delivery, heart failure therapy with carvedilol, spironolactone and furosemide was initiated, but carvedilol was discontinued due to hypotension. On postpartum day 39, she was readmitted with worsening dyspnea. Breastfeeding was ceased. Although bisoprolol and empagliflozin were initiated, LVEF further dropped to 27%. She was discharged with NYHA functional class III. Because LVEF remained impaired despite ongoing heart failure therapy, sacubitril/valsartan was initiated on postpartum day 122. Subsequently, LVEF improved to 60%, and NT-pro BNP decreased to 569 pg/ml. The patient became asymptomatic and tolerated therapy well. Discussion This case highlights the complexity of PPCM management. Sacubitril/valsartan may serve as an effective therapeutic option for PPCM patients who are intolerant intolerant to conventional therapy.