AccScience Publishing / BH / Volume 1 / Issue 2 / DOI: 10.36922/bh.1115
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Pedunculated left endoventricular thrombosis complicated by cerebral stroke in patient with suspected peripartum cardiomyopathy: A case report

Kristian Galanti1† Roberta Magnano2† Laura Pezzi2† Mario Di Marino1† Alberto D’ Alleva2 Daniele Forlani2 Piergiusto Vitulli2 Vincenzo Di Egidio3 Gabriele Di Giammarco4 Leonardo Paloscia2 Sabina Gallina1 Massimo Di Marco2†*
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1 Department of Neuroscience, Imaging and Clinical Sciences, G. D’Annunzio University of Chieti-Pescara, 66100, Chieti, Italy
2 Department of Cardiology and ICCU, Santo Spirito Hospital, Pescara, 65124, Italy
3 Department of Radiology, Santo Spirito Hospital, Pescara, 65124, Italy
4 Department of Cardiac Surgery, G. D’Annunzio University of Chieti-Pescara, Chieti, 66100, Italy
Brain & Heart 2023, 1(2), 1115
Submitted: 21 June 2023 | Accepted: 12 October 2023 | Published: 3 November 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( )

Peripartum cardiomyopathy (PPMC) is an infrequent form of cardiomyopathy, whose main presentation is characterized by systolic dysfunction that commonly emerges in the early postpartum period. Acute heart failure symptoms such as congestion and dyspnea are common manifestations of PPMC. Here, we present a case of a 32-year-old female who, after hospitalization, manifested dyspnea and thoracic pain linked to the findings a left endoventricular thrombus. After the admission to the intensive cardiovascular care unit, heart failure and anticoagulant therapies as well as non-steroidal anti-inflammatory drugs were administered, leading to initial improvement of the left ventricular global function. Five days after the treatment, the patient experienced aphasia and right hemiplegia. The cerebral angiography documented an M1 segment occlusion. After treating the occlusion with stent retriever thrombectomy, the symptoms regressed and she attained full recovery. Therefore, surgical thrombectomy should be prioritized as the treatment approach to removing the pedunculated left ventricular thrombus, considering the apical morphology of the pedunculated left ventricular thrombus and if the anticoagulant therapy gives rise to side effects.

Peripartum cardiomyopathy
Apical thrombus
Stent retriever thrombectomy
Surgical thrombectomy
  1. Honigberg MC, Givertz MM, 2019, Peripartum cardiomyopathy. BMJ, 364: k5287.


  1. Sliwa K, Hilfiker-Kleiner D, Petrie MC, et al., 2010, Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: A position statement from the heart failure association of the European society of cardiology working group on peripartum cardiomyopathy. Eur J Heart Fail, 12: 767–778. https://doi: 10.1093/eurjhf/hfq120


  1. Kolte D, Khera S, Aronow WS, et al., 2014, Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States: A nationwide population-based study. J Am Heart Assoc, 3: e001056.


  1. Bültmann BD, Klingel K, Näbauer M, et al., 2005 High prevalence of viral genomes and inflammation in peripartum cardiomyopathy. Am J Obstet Gynecol, 193: 363–365.


  1. Elkayam U, 2011, Clinical characteristics of peripartum cardiomyopathy in the United States: Diagnosis, prognosis, and management. J Am Coll Cardiol, 58: 659–670.


  1. Davis MB, Arany Z, McNamara DM, et al., 2020, Peripartum cardiomyopathy: JACC state-of-the-art review. J Am Coll Cardiol, 75: 207–221.


  1. Amos AM, Jaber WA, Russell WA, 2006, Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J, 152: 509–513.


  1. Afana M, Brinjikji W, Kao D, et al., 2016, Characteristics and in-hospital outcomes of peripartum cardiomyopathy diagnosed during delivery in the United States from the nationwide inpatient sample (NIS) database. J Card Fail, 22: 512–519.


  1. Gentry MB, Dias JK, Luis A, et al., 2010, African-American women have a higher risk for developing peripartum cardiomyopathy. J Am Coll Cardiol, 55: 654–659.


  1. Kao, DP, Hsich E, Lindenfeld J, 2013, Characteristics, adverse events, and racial differences among delivering mothers with peripartum cardiomyopathy. JACC Heart Fail, 1: 409–416.


  1. Bello N, Rendon, I.S.H, Arany Z, 2013, The relationship between pre-eclampsia and peripartum cardiomyopathy: A systematic review and meta-analysis. J Am Coll Cardiol, 62: 1715–1723.


  1. Brenner B, 2004, Haemostatic changes in pregnancy. Thromb Res, 114: 409–414.


  1. Hellgren M, 2003, Hemostasis during normal pregnancy and puerperium. Semin Thromb Hemost, 29: 125–130.


  1. Sliwa K, Mebazaa A, Hilfiker-Kleiner D, et al., 2017, Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM): EURObservational Research Programme in conjunction with the heart failure association of the European society of cardiology study group on PPCM. Eur J Heart Fail, 19: 1131–1141.


  1. Arany Z, Elkayam U, 2016, Peripartum cardiomyopathy. Circulation, 133: 1397–409.


  1. Sliwa K, Blauwet L, Tibazarwa K, et al., 2010, Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: A proof-of-concept pilot study. Circulation, 121: 1465–1473.


  1. Ruys TPE, Maggioni A, Johnson MR, et al., 2014, Cardiac medication during pregnancy, data from the ROPAC. Int J Cardiol, 177: 124–128.


  1. Goldsmith J, 2011, Drugs in pregnancy and lactation: A reference guide to fetal and neonatal risk, 9th edition. Am J Health Syst Pharm, 68: 2301–2301.


  1. Gatti G, Poli S, Benussi B, et al., 2018, Left ventricular thrombectomy in myocarditis: The epicardial scan and video-assisted transaortic approach. Minim Invasive Ther Allied Technol, 27: 101–104.


  1. Osada H, Nakajima H, Meshii K, et al., 2015, Transmitral, video-assisted left ventricular thrombectomy. Eur J Cardiothorac Surg, 47: e44–e45.


  1. Bolcal C, Kadan M, Kubat E, et al., 2019, Surgical treatment of a left ventricular apical thrombus via robotic surgery. J Card Surg, 34: 216–218.
Conflict of interest
The authors declare that they have no competing interests.
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Brain & Heart, Electronic ISSN: 2972-4139 Published by AccScience Publishing