Biventricular Assist Device as a Bridge to Cardiac Transplantation in the Treatment of Peripartum Cardiomyopathy

Peripartum cardiomyopathy is an unexpected complication of the puerperium with a high mortality rate. Appropriate therapy requires accurate identification of this disease, which is frequently difficult in a patient who has been previously healthy. Medical therapy using alteration of intravascular volume (to optimize ventricular preload), the addition of inotropic agents (to correct ventricular function), and intra-aortic balloon counterpulsation (to improve afterload reduction) is the first line of therapy. Surgical therapy, involving cardiac transplantation, is the ultimate treatment. This therapeutic modality, however, is limited by a lack of available organs for transplant. The development of devices to be used as a "bridge" is gaining acceptance and use as a pretransplantation procedure. This use may be considered particularly fundamental in otherwise healthy young women with peripartum cardiomyopathy. These patients frequently can have almost complete recovery and rehabilitation. We report the case of a young woman with peripartum cardiomyopathy who had a favorable outcome. We performed medical and surgical therapy, insertion of a temporary "bridge" device, and ultimately cardiac transplantation.