A 36-year-old female with past medical history of dilated congestive cardiomyopathy during her 5th pregnancy, was admitted in September 2019 at 24 weeks into her 6th pregnancy with symptoms of heart failure, ejection fraction (EF) of 30-35%, and BMI of 37. Guideline directed medical therapy (GDMT) was restarted with improvement in symptoms. Patient was discharged with close follow up as outpatient. In November 2019, patient was readmitted to the hospital at 35 weeks pregnant with exacerbation in heart failure symptoms. An echocardiogram demonstrated EF of 30-35% at this time. Labor was induced and patient delivered without complication. Patient continued to be followed outpatient with continued GDMT and a repeat echocardiogram in October 2020 demonstrated EF of 35-40%. Postpartum, patient's BMI was persistently greater than 35 and patient was referred to bariatric surgery. Patient underwent laparoscopic sleeve gastrectomy in March 2021 and her BMI dropped to 24.5 by November 2021. Repeat echo in October 2021 demonstrated EF of 55-60%. Refer to Figure 1 below for mean EF and weight over time.


Here we present a case of peripartum cardiomyopathy where bariatric surgery and associated weight loss with continued GDMT resulted in rapid EF improvement. As improvement in ejection fraction postpartum usually occurs within 6 months, the persistence in reduced EF at one-year postpartum highlights the potential contribution of obesity in inadequate response to GDMT in cases of peripartum cardiomyopathy. This study is limited by the report of a single case and further study is necessary.