Successful Emergency Cesarean Section in A Hypertrophic Cardiomyopathy Patient Presenting with Progressive Heart Failure and Non-sustained Ventricular Tachycardia: A Case Report and Literature Review

Physiological status in pregnancy varies with the gestational age and postpartum period. Although most pregnancies in patients with hypertrophic cardiomyopathy are uneventful, the underlying conditions pose additional risks for maternal cardiac events. A 42-year-old woman with a 14-year history of hypertrophic cardiomyopathy presented with sudden-onset intermittent chest tightness since 2 days prior, along with dyspnea and near-syncope, at a gestational age of 36 weeks and 5 days. Echocardiography revealed that the mid-left ventricular wall thickness was increased to 31.2 mm without systolic anterior motion of the mitral leaflet or significant mid-left ventricular and outflow tract pressure gradient. The multidisciplinary team decided to deliver at a gestational age of 37 weeks due to an episode of non-sustained ventricular tachycardia. Cesarean section was performed, with a cardiologist, a cardiothoracic surgeon, and an extracorporeal membrane oxygenation team on standby. A male baby was delivered uneventfully. No further non-sustained ventricular tachycardia was observed postpartum. However, worsening heart failure symptoms were observed on the third day postpartum, which were resolved via fluid restriction and diuretics. A single-chamber implantable cardioverter defibrillator was placed 6 months after delivery. With risk stratification and adequate corresponding levels of care, pregnancies in patients with hypertrophic cardiomyopathy can be managed uneventfully.