Left Ventricular Noncompaction Cardiomyopathy (LVNC) is a rare congenital cardiomyopathy with a highly variable clinical presentation; ranging from asymptomatic to severely symptomatic with heart failure, ventricular arrhythmias and systemic thromboembolism1. Literature regarding the impact of LVNC on pregnancy, as well as the impact of pregnancy on LVNC is scarce. We present the case of a successful pregnancy in a patient with LVNC, which may also suggest a unique relationship.
A 30-year-old primigravida woman was referred to our Obstetric Medicine clinic at 11 weeks’ gestation with known LVNC. She was diagnosed in adulthood during a workup for atypical chest pain, with subsequent cardiac imaging revealing typical LVNC morphology (markedly trabeculated LV apex)2. She had a family history of the condition, with her father having a more pronounced phenotype.
She had specialist multidisciplinary management during pregnancy and underwent serial echocardiographic monitoring. She declined prophylactic anticoagulation despite recommendations. She suffered no cardiac decompensation and was induced at 38+ weeks due to concerns of utero-placental insufficiency. There was no augmentation of labour and uterotonic agents were not used. Her peripartum period was largely uneventful, and she delivered a healthy baby vaginally.
LVNC is a rare cardiac disorder and management has not yet been standardised, with literature predominantly relying on case series and registries. Our case highlights that pregnancy can be managed successfully in patients with mild LVNC. Our patient tolerated her pregnancy well, with no cardiac deterioration.
Interestingly, there may be a suggestion that utero-placental dysfunction can occur in LVNC, independent of maternal cardiac status. This phenomenon has been described in a previous local study which also reported emergent delivery due to placental dysfunction, occurring in the absence of maternal cardiac compromise3. Further specific studies would be beneficial in this area.