[Severe acute left heart failure with pulmonary edema following cesarean section]

Severe left heart failure shortly after delivery in a previously asymptomatic young woman can be caused by a peripartum cardiomyopathy, an exacerbation of valvular heart disease due to both congenital or acquired etiologies, a sustained chronic tachyarrhythmia (tachycardiomyopathy), a fulminant pulmonary embolism, or an infective endocarditis.

2 days following cesarean section, a 36-year-old primipara without known previous heart disease suffered from severe left heart failure with pulmonary edema (Figure 1) due to an acute bacterial aortic valve endocarditis. The infecting organisms were beta-hemolytic group A streptococci. After diagnosis could be confirmed by conventional Doppler echocardiography and by transesophageal echocardiography (Figures 2 and 3), the clinical situation of the patient stabilized in a few days under an initial antibiotic regimen with vancomycin and gentamicin, diuretics and catecholamines, followed by diuretics and ACE inhibitor. 14 days after cesarean delivery, aortic valve replacement could be performed under hemodynamically stable conditions.

Although postpartal endocarditis is rarely described in the era of peripartum antibiotic prophylaxis, it should be considered in the differential diagnosis of patients with heart failure or fever in pregnancy, following delivery or cesarean section. The prognosis of peripartal endocarditis as a life-threatening disease is determined by an accurate and immediate diagnosis.