Venoarterial extracorporeal membrane oxygenation for peripartum cardiomyopathy complicated by severe preeclampsia: a case report with 5-year follow-up.

BACKGROUND: Peripartum cardiomyopathy (PPCM) coexisting with severe preeclampsia is uncommon and diagnostically challenging because dyspnea, pulmonary edema, and cardiac dysfunction may be attributed to either condition. Long-term outcomes after rescue mechanical support remain poorly documented. CASE PRESENTATION: A 28-year-old primigravida at 37 + 6 weeks presented with 2 days of worsening orthopnea, dyspnea, and cough. At 15 + 3 weeks, electrocardiography had shown complete left bundle branch block, although left ventricular ejection fraction (LVEF) was 61%. On admission, blood pressure was 159/120 mmHg, heart rate 157 beats/min, urine protein was positive, N-terminal pro-B-type natriuretic peptide (NT-proBNP) was 5,660 pg/ml, and echocardiography showed an LVEF of 26%. Severe preeclampsia and acute heart failure due to PPCM were diagnosed. Labetalol, magnesium sulfate, and furosemide were administered, followed by emergency cesarean delivery of a 2,880-g male infant (Apgar scores, 8 and 10). Persistent postoperative hemodynamic instability despite mechanical ventilation and pharmacotherapy prompted multidisciplinary initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO). She was successfully decannulated on day 4 and discharged on day 21 with an LVEF of 44%. NT-proBNP normalized by 6 months, LVEF exceeded 50% by 9 months, and at 5 years LVEF was 59% and NT-proBNP was 20.9 pg/ml. CONCLUSION: This case provides rare 5-year documentation of sustained myocardial recovery after VA-ECMO in PPCM with severe preeclampsia. In peripartum patients with severe hypertension and respiratory symptoms, an LVEF below 45% should prompt evaluation for PPCM; timely echocardiography, multidisciplinary care, and early VA-ECMO may bridge refractory hemodynamic instability to recovery, followed by prolonged cardiac surveillance.