Peripartum cardiomyopathy and antiphospholipid syndrome: a rare association revealed by a right ventricular thrombus. A case report

Peripartum cardiomyopathy (PPCM) is uncommon, and its association with antiphospholipid syndrome (APS) and right ventricular (RV) thrombus is exceptional. We report a 33-year-old woman who, three months after cesarean delivery for severe preeclampsia, developed acute heart failure with severe biventricular dysfunction requiring mechanical ventilation. An RV thrombus was identified; two computed tomographic pulmonary angiograms, one week apart, were negative for pulmonary embolism. Thrombophilia work-up disclosed persistently positive lupus anticoagulant on repeat testing 12 weeks apart, supporting APS. Therapeutic anticoagulation led to complete thrombus resolution after 10 days, and optimized heart failure therapy was followed by hemodynamic improvement and successful extubation. Coronary angiography ruled out ischemic heart disease, and endomyocardial biopsy showed no histologic evidence of myocarditis, supporting PPCM. Myocardial recovery was partial, requiring follow-up within an advanced heart failure program. This case highlights the need to evaluate secondary prothrombotic conditions, particularly APS, and to institute early anticoagulation in PPCM with intracardiac thrombosis.