Left ventricular apical infection and rupture complicating left ventricular assist device explantation in 2 women with postpartum cardiomyopathy.
Postpartum cardiomyopathy is rare form of cardiac failure, with the potential for cardiac function to recover to normal. When medical therapy fails to control symptoms or haemodynamic stability, circulatory support with a ventricular assist device may be considered as a bridge to cardiac transplantation. We describe 2 patients with severe postpartum cardiomyopathy, in whom cardiac function recovered sufficiently during mechanical circulatory assistance to enable device explantation. Bacteremia during device support was treated with chronic suppressive antibiotics, yet after cannula explantation and ventricular repair, residual infection led to destruction of the primary repair, with formation of a left ventricular pseudoaneurysm. This is a complication of device support not previously reported. Surgery was necessary to repair the infected ventricular cannula site. Both patients recovered; however one patient developed recurrent cardiomyopathy 4 months later.
Kotschet
Emily
E
Cardiovascular Department, Royal Jubilee Hospital, Victoria, Canada. ekotschet@yahoo.ca
Aggarwal
Ann
A
Esmore
Donald
D
Kaye
David
D
D000328:Adult; D017541:Aneurysm, False / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D000785:Aneurysm, Infected / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D002303:Cardiac Output, Low / Q000209:etiology / Q000382:microbiology; D020878:Device Removal; D005260:Female; D006322:Heart Aneurysm / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D006352:Heart Ventricles / Q000382:microbiology*; D006353:Heart-Assist Devices / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000209:etiology; D011247:Pregnancy; D016459:Prosthesis-Related Infections / Q000150:complications / Q000188:drug therapy*; D011644:Puerperal Disorders / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors; D013997:Time Factors