Cardiomyopathy During A Partial Molar Pregnancy

Abstract

<h3>Background</h3> Molar pregnancies are associated with increased maternal complications, notably hyperemesis gravidarum, pre-eclampsia, or development of gestational trophoblastic neoplasia, but rarely cardiomyopathy. We present a case of a partial molar pregnancy complicated by new-onset heart failure. <h3>Case</h3> A 38-year-old female G9P7017 patient at 17 weeks gestation with an unremarkable past medical history presented to the emergency department with worsening dyspnea, orthopnea, peripheral edema, and a 20-pound weight gain. Initial vital signs were notable for sinus tachycardia with a heart rate of 120 beats/min and a blood pressure of 131/94 mmHg. Her BNP was >35,000 pg/mL, with an initial troponin of 0.08 ng/mL peaking at 0.092 ng/mL. TSH was 0.07 uIU/mL, and free T4 was 0.95 ng/dL. ECG showed no acute ischemic changes. Transthoracic echocardiography (TTE) showed a dilated cardiomyopathy with global hypokinesis and a newly reduced left ventricular ejection fraction (LVEF) of 21%. Right heart catheterization showed CVP 9, PCWP 29, and CI 2.33. Pelvic ultrasonography demonstrated omphalocele, intracranial abnormalities, and placentomegaly with beta-hCG >1,000,000 mIU/mL, consistent with a partial molar pregnancy. <h3>Decision-making</h3> Multidisciplinary teams from maternal fetal medicine, general cardiology, and heart failure collaborated to provide care for this patient. The mechanism by which her molar pregnancy led to her cardiomyopathy is unclear, but it was believed that continuation of the pregnancy could lead to worsening or persistent heart failure. She underwent successful dilation and evacuation and products of conception confirmed a partial mole with karyotype of 69 XXX. She was ultimately discharged on neurohormonal blockade. TTE three months post discharge demonstrated an improved LVEF of 40%. Her beta-hCG level downtrended appropriately to 9 mIU/mL at the most recent follow-up. <h3>Conclusion</h3> Partial molar pregnancy can be a rare but important cause of heart failure during pregnancy. Removal of the molar pregnancy and initiating neurohormonal blockade can lead to myocardial recovery. The mechanism by which molar pregnancy leads to cardiomyopathy is unclear, warranting additional research.