Advertisement

Contemporary Management of Cardiogenic Shock During Pregnancy

      Highlights

      • Cardiogenic shock is a serious diagnosis in the peripartum period.
      • Several mechanical circulatory-support devices can be used safely during pregnancy.
      • Management of peripartum cardiogenic shock relies on accurate shock phenotyping.

      ABSTRACT

      Cardiogenic shock is the most extreme cardiovascular disease state during pregnancy. Peripartum cardiomyopathy is the most common cause of cardiogenic shock toward the end of pregnancy and in the early postpartum period. Therapy for cardiogenic shock relies on appropriate phenotyping of shock etiology, severity and ventricular predominance, which are critical in the appropriate selection of medical and mechanical therapy. Mechanical circulatory support may be used as a bridge to recovery or as definitive therapy. Intra-aortic balloon pumps, percutaneous left ventricular assist devices and venoarterial extracorporeal circulatory devices have been successfully used in pregnancy and the postpartum period. The most commonly used mechanical therapy in the pregnant patient is extracorporeal membranous oxygenation circulatory support. The use of mechanical circulatory devices in peripartum cardiomyopathy has contributed to improved survival rates in recent years. Further efforts to identify the optimal mechanical circulatory support strategy for peripartum cardiomyopathy and cardiogenic shock in the peripartum period are needed.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiac Failure
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sharma S
        • Thomas SS
        Management of heart failure and cardiogenic shock in pregnancy.
        Curr Treat Options Cardio Med. 2019; 21: 83https://doi.org/10.1007/s11936-019-0797-1
        • Banayan J
        • Rana S
        • Mueller A
        • Tung A
        • Ramadan H
        • Arany Z
        • et al.
        Cardiogenic shock in pregnancy: Analysis from the National Inpatient Sample.
        Hypertens Pregn. 2017; 36: 117-123https://doi.org/10.1080/10641955.2016.1242606
        • Ruys TPE
        • Roos-Hesselink JW
        • Hall R
        • Subirana-Domènech MT
        • Grando-Ting J
        • Estensen M
        • et al.
        Heart failure in pregnant women with cardiac disease: data from the ROPAC.
        Heart. 2014; 100: 231-238https://doi.org/10.1136/heartjnl-2013-304888
        • Banayan J
        • Rana S
        • Mueller A
        • Tung A
        • Ramadan H
        • Arany Z
        • et al.
        Cardiogenic shock in pregnancy: analysis from the national inpatient sample.
        Preg Hyperten. 2016; 6: 220-221https://doi.org/10.1016/j.preghy.2016.08.171
        • Ouzounian JG
        • Elkayam U
        Physiologic changes during normal pregnancy and delivery.
        Cardiol Clin. 2012; 30: 317-329https://doi.org/10.1016/j.ccl.2012.05.004
        • Datta S
        • Kodali BS
        • Segal S
        Maternal physiological changes during pregnancy, labor, and the postpartum period.
        Obstetric Anesthesia Handbook. Springer, New York, NY2010: 1-14https://doi.org/10.1007/978-0-387-88602-2_1
        • Kasula S
        • Beeram S
        • Janapati R
        • Garre I
        Structural and functional changes in maternal heart during pregnancy: an echocardiographic study.
        Ind J Car Dis Wom. 2017; 02: 72-76https://doi.org/10.1055/s-0038-1624065
        • Ginwalla M
        • Pillai D
        • Gandhi S
        Use of intra-aortic balloon counterpulsation during emergent cesarean section in a pregnant patient with myocardial infarction.
        J Invas Cardiol. 2010; 22: E104-E106
        • Telukuntla KS
        • Estep JD
        Acute mechanical circulatory support for cardiogenic shock.
        Methodist Debakey Cardiovasc J. 2020; 16: 27-35https://doi.org/10.14797/mdcj-16-1-27
        • Rihal CS
        • Naidu SS
        • Givertz MM
        • Szeto WY
        • Burke JA
        • Kapur NK
        • et al.
        2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care.
        J Am Coll Cardiol. 2015; 65: e7-26https://doi.org/10.1016/j.jacc.2015.03.036
        • Cong J
        • Fan T
        • Yang X
        • Squires JW
        • Cheng G
        • Zhang L
        • et al.
        Structural and functional changes in maternal left ventricle during pregnancy: a three-dimensional speckle-tracking echocardiography study.
        Cardiovasc Ultrasound. 2015; 13: 6https://doi.org/10.1186/1476-7120-13-6
        • Kolte D
        • Khera S
        • Aronow WS
        • Palaniswamy C
        • Mujib M
        • Ahn C
        • et al.
        Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States: a nationwide population-based study.
        J Am Heart Assoc. 2014; 3e001056https://doi.org/10.1161/JAHA.114.001056
        • Isogai T
        • Kamiya CA
        Worldwide incidence of peripartum cardiomyopathy and overall maternal mortality.
        Int Heart J. 2019; 60: 503-511https://doi.org/10.1536/ihj.18-729
        • Roberts S
        Rac MWF. Cardiogenic Shock.
        in: Phelan JP Pacheco LD Foley MR Saade GR Dildy GA Belfort MA Critical Care Obstetrics. John Wiley & Sons, New York, NY2018: 631-639https://doi.org/10.1002/9781119129400.ch39
        • Sliwa K
        • van Hagen IM
        • Budts W
        • Swan L
        • Sinagra G
        • Caruana M
        • et al.
        Pulmonary hypertension and pregnancy outcomes: data from the Registry Of Pregnancy and Cardiac Disease (ROPAC) of the European Society of Cardiology: pulmonary hypertension in pregnancy.
        Eur J Heart Fail. 2016; 18: 1119-1128https://doi.org/10.1002/ejhf.594
        • Cade JR
        • Szarf G
        • de Siqueira ME.M
        • Chaves Á
        • Andréa JC.M
        • Figueira HR
        • et al.
        Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients.
        Eur Heart J Cardiovasc Imag. 2017; 18: 54-61https://doi.org/10.1093/ehjci/jew021
        • Elkayam U
        • Jalnapurkar S
        • Barakkat MN
        • Khatri N
        • Kealey AJ
        • Mehra A
        • et al.
        Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011.
        Circulation. 2014; 129: 1695-1702https://doi.org/10.1161/CIRCULATIONAHA.113.002054
        • Kaur K
        • Bhardwaj M
        • Kumar P
        • Singhal S
        • Singh T
        • Hooda S
        Amniotic fluid embolism.
        J Anaesthesiol Clin Pharmacol. 2016; 32: 153https://doi.org/10.4103/0970-9185.173356
        • Rudra A
        • Chatterjee S
        • Sengupta S
        • Nandi B
        • Mitra J
        Amniotic fluid embolism.
        Indian J CritCare Med. 2009; 13: 129-135https://doi.org/10.4103/0972-5229.58537
        • O'Shea A
        • Eappen S
        Amniotic fluid embolism.
        Int Anesthesiol Clin. 2007; 45: 17-28https://doi.org/10.1097/AIA.0b013e31802b8853
        • Sliwa K
        • Hilfiker-Kleiner D
        • Petrie MC
        • Mebazaa A
        • Pieske B
        • Buchmann E
        • et al.
        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. 2010; 12: 767-778https://doi.org/10.1093/eurjhf/hfq120
        • Robbins KS
        • Krause M
        • Nguyen AP
        • Almehlisi A
        • Meier A
        • Schmidt U
        • et al.
        Peripartum cardiomyopathy: current options for treatment and cardiovascular support.
        J Cardiothorac Vasc Anesthes. 2019; 33: 2814-2825https://doi.org/10.1053/j.jvca.2019.02.010
        • Bouabdallaoui N
        • Mouquet F
        • Lebreton G
        • Demondion P
        • Le Jemtel TH
        • Ennezat PV
        Current knowledge and recent development on management of peripartum cardiomyopathy.
        Eur Heart J: Acute CardiovascCare. 2017; 6: 359-366https://doi.org/10.1177/2048872615612465
        • Hilfiker-Kleiner D
        • Sliwa K
        Pathophysiology and epidemiology of peripartum cardiomyopathy.
        Nat Rev Cardiol. 2014; 11: 364-370https://doi.org/10.1038/nrcardio.2014.37
        • Goland S
        • Modi K
        • Bitar F
        • Janmohamed M
        • Mirocha JM
        • Czer LS.C
        • et al.
        Clinical profile and predictors of complications in peripartum cardiomyopathy.
        J Card Fail. 2009; 15: 645-650https://doi.org/10.1016/j.cardfail.2009.03.008
        • Davis MB
        • Arany Z
        • McNamara DM
        • Goland S
        • Peripartum cardiomyopathy Elkayam U
        J Am Coll Cardiol. 2020; 75: 207-221https://doi.org/10.1016/j.jacc.2019.11.014
        • McNamara DM
        • Elkayam U
        • Alharethi R
        • Damp J
        • Hsich E
        • Ewald G
        • et al.
        Clinical outcomes for peripartum cardiomyopathy in North America.
        J Am Coll Cardiol. 2015; 66: 905-914https://doi.org/10.1016/j.jacc.2015.06.1309
        • Collins R
        • Yusuf S
        • Peto R
        Overview of randomised trials of diuretics in pregnancy.
        Br Med J (Clin Res Ed). 1985; 290: 17-23https://doi.org/10.1136/bmj.290.6461.17
        • Elkayam U
        • Goland S
        • Pieper PG
        • Silversides CK
        High-risk cardiac disease in pregnancy.
        J Am Coll Cardiol. 2016; 68: 396-410https://doi.org/10.1016/j.jacc.2016.05.048
        • Stapel B
        • Kohlhaas M
        • Ricke-Hoch M
        • Haghikia A
        • Erschow S
        • Knuuti J
        • et al.
        Low STAT3 expression sensitizes to toxic effects of β-adrenergic receptor stimulation in peripartum cardiomyopathy.
        Eur Heart J. 2017; 38: 349-361https://doi.org/10.1093/eurheartj/ehw086
        • Bozkurt B
        • Colvin M
        • Cook J
        • Cooper LT
        • Deswal A
        • Fonarow GC
        • et al.
        Current diagnostic and treatment strategies for specific dilated cardiomyopathies: a scientific statement from the American Heart Association.
        Circulation. 2016; 134xxx–xhttps://doi.org/10.1161/CIR.0000000000000455
        • Sliwa K
        • Blauwet L
        • Tibazarwa K
        • Libhaber E
        • Smedema J-P
        • Becker A
        • et al.
        Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study.
        Circulation. 2010; 121: 1465-1473https://doi.org/10.1161/CIRCULATIONAHA.109.901496
        • Zagelbaum NK
        • Bhinder J
        • Gupta CA
        • Frishman WH
        • Aronow WS
        Peripartum cardiomyopathy incidence, risk factors, diagnostic criteria, pathophysiology, and treatment options.
        Cardiol Rev. 2020; 28: 148-155https://doi.org/10.1097/CRD.0000000000000249
        • Stergiopoulos K
        • Lima FV
        Peripartum cardiomyopathy-diagnosis, management, and long term implications.
        Trends Cardiovasc Med. 2019; 29: 164-173https://doi.org/10.1016/j.tcm.2018.07.012
        • Heidenreich PA
        • Bozkurt B
        • Aguilar D
        • Allen LA
        • Byun JJ
        • Colvin MM
        • et al.
        2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
        Circulation. 2022; 145: e895-1032https://doi.org/10.1161/CIR.0000000000001063
        • Bouabdallaoui N
        • Demondion P
        • Leprince P
        • Lebreton G
        Short-term mechanical circulatory support for cardiogenic shock in severe peripartum cardiomyopathy: La Pitié-Salpêtrière experience.
        Interact Cardiovasc Thorac Surg. 2017; 25: 52-56https://doi.org/10.1093/icvts/ivx106
        • Blumer V
        • Arcay L
        • Mendirichaga R
        • Chaparro S
        Mechanical circulatory support for peripartum cardiomyopathy: a systematic review.
        J Card Fail. 2017; 23: S121https://doi.org/10.1016/j.cardfail.2017.07.357
        • Loyaga-Rendon RY
        • Pamboukian SV
        • Tallaj JA
        • Acharya D
        • Cantor R
        • Starling RC
        • et al.
        Outcomes of patients with peripartum cardiomyopathy who received mechanical circulatory support: data from the Interagency Registry for Mechanically Assisted Circulatory Support.
        Circ Heart Fail. 2014; 7: 300-309https://doi.org/10.1161/CIRCHEARTFAILURE.113.000721
        • Willcox TW
        • Stone P
        • Milsom FP
        • Connell H
        Cardiopulmonary bypass in pregnancy: possible new role for the intra-aortic balloon pump.
        J Extra Corpor Technol. 2005; 37: 189-191
        • Lin TY
        • Chiu KM
        • Shieh JS
        • Chu SH
        Emergency redo mitral valve replacement in a pregnant woman at third trimester: case report and literature review.
        Circ J. 2008; 72: 1715-1717https://doi.org/10.1253/circj.cj-07-0775
        • Allen JN
        • Wewers MD
        Acute myocardial infarction with cardiogenic shock during pregnancy: treatment with intra-aortic balloon counterpulsation.
        Crit Care Med. 1990; 18: 888-889https://doi.org/10.1097/00003246-199008000-00020
        • Garry D
        • Leikin E
        • Fleisher AG
        • Tejani N
        Acute myocardial infarction in pregnancy with subsequent medical and surgical management.
        Obstet Gynecol. 1996; 87: 802-804
        • Jha N
        • Jha AK
        • Chand Chauhan R
        • Chauhan NS
        Maternal and fetal outcome after cardiac operations during pregnancy: a meta-analysis.
        Ann Thorac Surg. 2018; 106: 618-626https://doi.org/10.1016/j.athoracsur.2018.03.020
        • Gevaert S
        • Van Belleghem Y
        • Bouchez S
        • Herck I
        • De Somer F
        • De Block Y
        • et al.
        Acute and critically ill peripartum cardiomyopathy and “bridge to” therapeutic options: a single center experience with intra-aortic balloon pump, extra corporeal membrane oxygenation and continuous-flow left ventricular assist devices.
        Crit Care. 2011; 15: R93https://doi.org/10.1186/cc10098
        • Khan MH
        • Corbett BJ
        • Hollenberg SM
        Mechanical circulatory support in acute cardiogenic shock.
        F1000 Prime Rep. 2014; 6: 91https://doi.org/10.12703/P6-91
        • Elkayam U
        • Schäfer A
        • Chieffo A
        • Lansky A
        • Hall S
        • Arany Z
        • et al.
        Use of Impella heart pump for management of women with peripartum cardiogenic shock.
        Clin Cardiol. 2019; 42: 974-981https://doi.org/10.1002/clc.23249
        • Sieweke JT
        • Pfeffer TJ
        • Berliner D
        • König T
        • Hallbaum M
        • Napp LC
        • et al.
        Cardiogenic shock complicating peripartum cardiomyopathy: importance of early left ventricular unloading and bromocriptine therapy.
        Eur Heart J Acute Cardiovasc Care. 2020; 9: 173-182https://doi.org/10.1177/2048872618777876
        • Zimmerman H
        • Bose R
        • Smith R
        • Copeland JG
        Treatment of peripartum cardiomyopathy with mechanical assist devices and cardiac transplantation.
        Ann Thorac Surg. 2010; 89: 1211-1217https://doi.org/10.1016/j.athoracsur.2009.12.064
        • Fatehi Hassanabad A
        • McBride SA
        • Hill MD
        • Kent WDT
        Mechanical circulatory support for the management of complex peripartum cardiomyopathy.
        JACC Case Rep. 2020; 2: 154-158https://doi.org/10.1016/j.jaccas.2019.08.033
        • Aggarwal A
        • Modi S
        • Kumar S
        • Korrapati C
        • Tatooles A
        • Pappas P
        • et al.
        Use of a single-circuit CentriMag® for biventricular support in postpartum cardiomyopathy.
        Perfusion. 2013; 28: 156-159https://doi.org/10.1177/0267659112464713
        • Mandawat A
        • Rao SV
        Percutaneous mechanical circulatory support devices in cardiogenic shock.
        Circ: Cardiovasc Interven. 2017; 10xxx–xhttps://doi.org/10.1161/CIRCINTERVENTIONS.116.004337
        • Sebastian NA
        • Spence AR
        • Bouhadoun S
        • Abenhaim HA
        Extracorporeal membrane oxygenation in pregnant and postpartum patients: a systematic review.
        J Matern-Fetal Neonat Med. 2020; (Accessed December 20): 1-11https://doi.org/10.1080/14767058.2020.1860932
        • Moore SA
        • Dietl CA
        • Coleman DM
        Extracorporeal life support during pregnancy.
        J Thorac CardiovascSurg. 2016; 151: 1154-1160https://doi.org/10.1016/j.jtcvs.2015.12.027
        • Zhang JJY
        • Ong JAH
        • Syn NL
        • Lorusso R
        • Tan CS
        • MacLaren G
        • et al.
        Extracorporeal membrane oxygenation in pregnant and postpartum women: a systematic review and meta-regression analysis.
        J Intens Care Med. 2021; 36: 220-228https://doi.org/10.1177/0885066619892826
        • Agerstrand C
        • Abrams D
        • Biscotti M
        • Moroz L
        • Rosenzweig EB
        • D'Alton M
        • et al.
        Extracorporeal membrane oxygenation for cardiopulmonary failure during pregnancy and postpartum.
        Ann Thorac Surg. 2016; 102: 774-779https://doi.org/10.1016/j.athoracsur.2016.03.005
        • Biderman P
        • Carmi U
        • Setton E
        • Fainblut M
        • Bachar O
        • Einav S
        Maternal salvage with extracorporeal life support: lessons learned in a single center.
        Anesthes Analges. 2017; 125: 1275-1280https://doi.org/10.1213/ANE.0000000000002262
        • Hou X
        • Guo L
        • Zhan Q
        • Jia X
        • Mi Y
        • Li B
        • et al.
        Extracorporeal membrane oxygenation for critically ill patients with 2009 Influenza A (H1N1)-related acute respiratory distress syndrome: preliminary experience from a single center: ECMO and H1N1 influenza.
        Artif Org. 2012; 36: 780-786https://doi.org/10.1111/j.1525-1594.2012.01468.x
        • Naoum EE
        • Chalupka A
        • Haft J
        • MacEachern M
        • Vandeven CJM
        • Easter SR
        • et al.
        Extracorporeal life support in pregnancy: a systematic review.
        JAHA. 2020; 9e016072https://doi.org/10.1161/JAHA.119.016072
        • Ong J
        • Zhang JJY
        • Lorusso R
        • MacLaren G
        • Ramanathan K
        Extracorporeal membrane oxygenation in pregnancy and the postpartum period: a systematic review of case reports.
        Int J Obstet Anesthes. 2020; 43: 106-113https://doi.org/10.1016/j.ijoa.2020.04.004
        • Park SH
        • Chin JY
        • Choi MS
        • Choi JH
        • Choi YJ
        • Jung KT
        Extracorporeal membrane oxygenation saved a mother and her son from fulminant peripartum cardiomyopathy: ECMO in full-term pregnancy.
        J Obstet Gynaecol Res. 2014; 40: 1940-1943https://doi.org/10.1111/jog.12421
        • Choi JY
        • Kang YJ
        • Jang HM
        • Jung HY
        • Cho JH
        • Park SH
        • et al.
        Nafamostat mesilate as an anticoagulant during continuous renal replacement therapy in patients with high bleeding risk: a randomized clinical trial.
        Medicine (Baltimore). 2015; 94: e2392https://doi.org/10.1097/MD.0000000000002392
        • Ngatchou W
        • Ramadan ASE
        • Van Nooten G
        • Antoine M
        Left tilt position for easy extracorporeal membrane oxygenation cannula insertion in late pregnancy patients.
        Interact Cardiovasc Thorac Surg. 2012; 15: 285-287https://doi.org/10.1093/icvts/ivs142
        • Kim HY
        • Jeon HJ
        • Yun JH
        • Lee JH
        • Lee GG
        • Woo SC
        Anesthetic experience using extracorporeal membrane oxygenation for cesarean section in the patient with peripartum cardiomyopathy: a case report.
        Korean J Anesthesiol. 2014; 66: 392https://doi.org/10.4097/kjae.2014.66.5.392
        • Baran DA
        • Grines CL
        • Bailey S
        • et al.
        SCAI clinical expert consensus statement on the classification of cardiogenic shock: this document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019.
        Catheter Cardiovasc Interv. 2019; (Accessed May 19ccd.28329)https://doi.org/10.1002/ccd.28329
        • Naidu SS
        • Baran DA
        • Jentzer JC
        • Hollenberg SM
        • van Diepen S
        • Basir MB
        • et al.
        SCAI SHOCK stage classification expert consensus update: a review and incorporation of validation studies.
        J Soc Cardiovasc Angiogr Intervent. 2022; 1100008https://doi.org/10.1016/j.jscai.2021.100008
        • Lund LH
        • Grinnemo KH
        • Svenarud P
        • van der Linden J
        • Eriksson MJ
        Myocardial recovery in peri-partum cardiomyopathy after continuous flow left ventricular assist device.
        J Cardiothorac Surg. 2011; 6: 150https://doi.org/10.1186/1749-8090-6-150
        • Oosterom L
        • de Jonge N
        • Kirkels J
        • Klöpping C
        • Lahpor J
        Left ventricular assist device as a bridge to recovery in a young woman admitted with peripartum cardiomyopathy.
        Neth Heart J. 2008; 16: 426-428https://doi.org/10.1007/BF03086192
        • Lueck S
        • Sindermann J
        • Martens S
        • Scherer M
        Mechanical circulatory support for patients with peripartum cardiomyopathy.
        J Artif Organs. 2016; 19: 305-309https://doi.org/10.1007/s10047-016-0891-z
        • Djordjevic I
        • Merkle J
        • Eghbalzadeh K
        • et al.
        The outcome of patients with peripartum cardiomyopathy and consecutive implantation of a left ventricular assist device.
        J Card Surg. 2021; 36: 2651-2657https://doi.org/10.1111/jocs.15598
        • Kwon JH
        • Tedford RJ
        • Ramu B
        • Witer LJ
        • Pope NH
        • Houston BA
        • et al.
        Heart transplantation for peripartum cardiomyopathy: outcomes over three decades.
        Ann Thorac Surg. 2022; (Accessed January)S0003497522000662https://doi.org/10.1016/j.athoracsur.2021.12.059
        • Rasmusson KD
        • Stehlik J
        • Brown RN
        • Renlund DG
        • Wagoner LE
        • Torre-Amione G
        • et al.
        Long-term outcomes of cardiac transplantation for peri-partum cardiomyopathy: a multiinstitutional analysis.
        J Heart Lung Transplant. 2007; 26: 1097-1104https://doi.org/10.1016/j.healun.2007.08.002
        • Rasmusson K
        • Brunisholz K
        • Budge D
        • Horne BD
        • Alharethi R
        • Folsom J
        • et al.
        Peripartum cardiomyopathy: post-transplant outcomes from the united network for organ sharing database.
        J Heart Lung Transplant. 2012; 31: 180-186https://doi.org/10.1016/j.healun.2011.11.018
        • Zhou AL
        • Etchill EW
        • Giuliano KA
        • Shou BL
        • Sharma K
        • Choi CW
        • et al.
        Bridge to transplantation from mechanical circulatory support: a narrative review.
        J Thorac Dis. 2021; 13: 6911-6923https://doi.org/10.21037/jtd-21-832
        • Bauersachs J
        • König T
        • Meer P
        • Petrie MC
        • Hilfiker-Kleiner D
        • Mbakwem A
        • et al.
        Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy.
        Eur J Heart Fail. 2019; 21: 827-843https://doi.org/10.1002/ejhf.1493
        • Bouabdallaoui N
        • Mastroianni C
        • Revelli L
        • Demondion P
        • Lebreton G
        Predelivery extracorporeal membrane oxygenation in a life-threatening peripartum cardiomyopathy: save both mother and child.
        Am J Emerg Med. 2015; 331713.e1–.e2https://doi.org/10.1016/j.ajem.2015.03.014
        • Samalavicius RS
        • Puodziukaite L
        • Radaviciute I
        • Norkiene I
        • Urbonas K
        • Misiuriene I
        • et al.
        Prophylactic use of an intra-aortic balloon pump in a high-risk patient with peripartum cardiomyopathy requiring cesarean delivery.
        Int J Obstet Anesth. 2018; 33: 67-71https://doi.org/10.1016/j.ijoa.2017.07.004
        • Mikami T
        • Kamiunten H
        Emergent caesarean section under mechanical circulatory support for acute severe peripartum cardiomyopathy.
        J Cardiol Cases. 2018; 17: 200-203https://doi.org/10.1016/j.jccase.2018.02.002
        • Ko RE
        • Chung CR
        • Yang JH
        • Jeon K
        • Suh GY
        • Oh S
        • et al.
        Use of extracorporeal membrane oxygenation in postpartum patients with refractory shock or respiratory failure.
        Sci Rep. 2021; 11: 887https://doi.org/10.1038/s41598-020-80423-w
        • Jawad K
        • Koziarz A
        • Dieterlen MT
        • Garbade J
        • Etz CD
        • Saeed D
        • et al.
        Long-term follow-up of mechanical circulatory support in peripartum cardiomyopathy (PPCM) refractory to medical management: a multicenter study.
        Life. 2022; 12: 87https://doi.org/10.3390/life12010087