Successful Induction of β-blocker Therapy for a Patient with Peripartum Cardiomyopathy Complicated with Significant Aortic Stenosis

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A 35-year-old female with pre-existing significant aortic stenosis was admitted due to congestive heart failure commencing six months after her fourth delivery, and was diagnosed as peripartum cardiomyopathy. Because of severe contractile dysfunction, the aortic valve pressure gradient had decreased remarkably, indicating low-output, low-gradient aortic stenosis. In addition to the conventional therapies of heart failure, steroid therapy and intravenous immunoglobulin therapy were administered for coexisting myocarditis. While effective, the therapies were incomplete to relieve her symptoms and improve the low output state. For severe left ventricular systolic dysfunction, β-blocker therapy was initiated despite preexisting aortic stenosis. After the successful induction of β-blocker therapy, the patient's symptoms improved gradually. Her left ventricular systolic function has continued to improve with β-blocker therapy over two years of follow-up, and the aortic valve pressure gradient is reaching the level prior to the peripartum cardiomyopathy. β-blocker therapy may constitute one option among the therapeutic strategies for intractable heart failure due to cardiomyopathy even if complicated with significant aortic stenosis.
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