Severe Peripartum Cardiomyopathy Complicated by Multiple Left Ventricular Thrombi and Systemic Embolic Events: A Case Report

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ID: 328536
2026
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Abstract
Abstract Background Peripartum cardiomyopathy (PPCM) is a potentially life-threatening cause of heart failure occurring towards the end of pregnancy or in the months following delivery. Severe PPCM may be complicated by intracardiac thrombi and systemic embolisation, favoured by left ventricular systolic dysfunction, ventricular dilatation, and the hypercoagulable state of the puerperium. Case summary A 36-year-old woman presented one month postpartum with acute decompensated heart failure. Transthoracic echocardiography showed severe left ventricular systolic dysfunction, with a left ventricular ejection fraction of 21%. Computed tomography demonstrated two large left ventricular thrombi and systemic embolic complications involving the spleen, kidneys, and liver, as well as splenic vein thrombosis. She was treated with guideline-directed heart failure therapy and therapeutic anticoagulation. Serial follow-up showed progressive left ventricular recovery and thrombus regression, with complete normalisation of left ventricular ejection fraction and full thrombus resolution by eight months. Discussion Severe PPCM should be considered a potentially thromboembolic disease, particularly in the presence of marked left ventricular dysfunction or atypical extracardiac symptoms. This case emphasises the importance of early recognition, systematic assessment for intracardiac and extracardiac thromboembolic complications, individualised anticoagulation, and close imaging follow-up.
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Authors Fadoua Achour, Soukaina Cherkaoui, Moustapha Atteyeh Sougal, Jamila Zarzour, Mohamed Cherti
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Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag685
URL
https://academic.oup.com/ehjcr/advance-article-pdf/doi/10.1093/ehjcr/ytag685/71030595/ytag685.pdf
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