Severe peripartum cardiomyopathy complicated by multiple left ventricular thrombi and systemic embolic events: a case report

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 embolization, favoured by left ventricular (LV) systolic dysfunction, ventricular dilatation, and the hypercoagulable state of the puerperium.

A 36-year-old woman presented 1-month postpartum with acute decompensated heart failure. Transthoracic echocardiography showed severe LV systolic dysfunction, with a LV ejection fraction (LVEF) of 21%. Computed tomography demonstrated two large LV 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 LV recovery and thrombus regression, with complete normalization of LVEF and full thrombus resolution by 8 months.

Severe PPCM should be considered a potentially thromboembolic disease, particularly in the presence of marked LV dysfunction or atypical extracardiac symptoms. This case emphasizes the importance of early recognition, systematic assessment for intracardiac and extracardiac thromboembolic complications, individualized anticoagulation, and close imaging follow-up.