Biventricular thrombi with a rare left ventricular septal thrombus in a patient with peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a potential complication of pregnancy, described as left ventricular (LV) dysfunction (characterised as LV ejection fraction < 45%) occurring towards the end of pregnancy or in the months following delivery. Decreased LV contractility can lead to various complications, including the formation of an LV thrombus. We report the case involving a woman in her 20s with a history of PPCM, who developed biventricular thrombi with a rare mid-septal LV thrombus months after diagnosis. Despite initial treatment with heparin and warfarin, the thrombi persisted. A switch to rivaroxaban led to the resolution of both thrombi. This case underscores the importance of early anticoagulation in patients with PPCM and the potential role of rivaroxaban as a treatment option in managing uncommon thrombi in these patients.