Perioperative Management of Decompensated Peripartum Cardiomyopathy With Severe Left Ventricular Dysfunction: A Case Report

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening cause of heart failure that may be difficult to distinguish from the physiological symptoms of pregnancy. We report the case of a 42-year-old woman at 34 weeks of gestation who presented with progressive dyspnea and was found to have severe global left ventricular systolic dysfunction with an ejection fraction of approximately 20%. Despite initial improvement with diuresis, she developed recurrent acute decompensated heart failure requiring intensive care unit readmission. Point-of-care ultrasonography (POCUS) demonstrated pulmonary congestion and reduced forward flow, with a left ventricular outflow tract velocity-time integral (LVOT VTI) of 10 cm. Following hemodynamic optimization with diuresis and inotropic support, cesarean delivery was performed under general anesthesia with invasive monitoring and titrated vasoactive support. Postoperatively, LVOT VTI increased to 15 cm with corresponding clinical improvement. This case highlights the value of serial hemodynamic assessment, including POCUS, and multidisciplinary perioperative management in severe PPCM with recurrent decompensation.