Biventricular assist device-induced recovery from acute heart failure in peripartum cardiomyopathy on cardiac magnetic resonance imaging.

1284 delivery, the treatment was converted into the use of the first Polish pulsatile ‐flow mechanical cir‐ culatory support system—POLCAS. First, the LV was supported by the cannulation from the LV to the aorta. Two weeks later, due to RV function de‐ terioration, the RV POLCAS system was implant‐ ed. The clinical course was complicated by device‐ ‐related thrombus formation despite anticoag‐ ulation and, therefore, the device was explant‐ ed on day 88 after delivery. At that stage, LVEF ranged between 25% and 30% on echocardiogra‐ phy. The subsequent cardiac MRI scan revealed a significant improvement in the contractility of the basal and mid segments of the LV, while api‐ cal akinesia and tethering were observed in the re‐ gion of the scar after removing the LV assist device (Supplementary material, Videos S3 and S4). The LV and RV volumes were normal with LVEF of 35% and RVEF of 46%. Importantly, on T1 mapping, the T1 signal dropped to 1104 ms (Figure 1). The pa‐ tient’s status gradually improved and the woman was discharged home with New York Heart Asso‐ ciation class II. At 6‐month follow ‐up, the level of N ‐terminal fragment of the prohormone brain natriuretic peptide decreased to 1019 pg/ml, and the high ‐sensitivity troponin T level was within reference range. Peripartum cardiomyopathy is a rare and potentially life ‐threatening condition. Sever‐ al studies demonstrated that the presence of LVEF <30% and left ventricular end ‐diastolic A 26‐year ‐old woman presented with acute‐ ‐onset heart failure 3 days after giving natu‐ ral birth to a healthy infant (gravida 1, para 1). Echocardiography revealed an enlarged left ventricular end ‐diastolic diameter of 68 mm, decreased left ventricular ejection fraction (LVEF) of 17%, and moderate mitral regurgi‐ tation. The patient was diagnosed with peri‐ partum cardiomyopathy (PPCM) and referred for cardiac magnetic resonance imaging (MRI), which confirmed a severely dilated left ventri‐ cle (LV) with impaired ejection fraction of 19% (Supplementary material, Videos S1 and S2). Right ventricular (RV) volumes and function were normal with RVEF of 52%. On T2‐weight‐ ed imaging, no rise in the T2 signal was not‐ ed. Importantly, T1‐mapping revealed a signif‐ icant increase in the T1 signal in the interven‐ tricular septum (T1 = 1352 ms; mean [SD] ref‐ erence range, 940.7 [49.2] ms) despite lack of late gadolinium enhancement (Figure 1). Extra‐ cellular volume (ECV) was significantly elevat‐ ed at 36%. Laboratory tests showed the elevat‐ ed levels of N ‐terminal fragment of the pro‐ hormone brain natriuretic peptide and high‐ ‐sensitivity troponin T: 10 275 pg/ml (reference range <125 pg/ml) and 52.78 ng/l (reference range <14 ng/l), respectively. In the following days, the patient developed car‐ diogenic shock and required arteriovenous extra‐ corporeal membrane oxygenation. On day 42 after Correspondence to: Joanna Petryka ‐Mazurkiewicz, MD, PhD, Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, ul. Alpejska 42, 04-628 Warszawa, Poland, phone: +48 22 343 43 42, email: jpetryka@ikard.pl Received: July 16, 2020. Revision accepted: August 18, 2020. Published online: August 26, 2020. Kardiol Pol. 2020; 78 (12): 1284-1285 doi:10.33963/KP.15586 Copyright by the Author(s), 2020