Bridge to recovery with a thoratec biventricular assist device for postpartum cardiomyopathy

A 25-year-old African-American woman developed shortness of breath 7 days after a spontaneous vaginal delivery. She was found by echocardiogram to have a left ventricular ejection fraction of 10% and was diagnosed with postpartum cardiomyopathy. Despite medical therapy including diuretics, an ace inhibitor, and a beta blocker, over the next 5 months, the patient had more than 12 hospital admissions for congestive heart failure. After accepting her in transfer, we placed her on multiple IV inotropes and observed no improvement. We then implanted a Thoratec Biventricular Assist Device. During 26 days of support, we conducted two weaning trials that documented return of cardiac function. We then pretreated her for 48 hours before device explantation. She was weaned off inotropic therapy over 2 weeks and discharged to home with normal cardiac function. Two years after explantation of the device, she has a left ventricular ejection fraction of 40% and is New York Heart Association functional class 1.