Peripartum Cardiomyopathy

Abstract

Peripartum cardiomyopathy is a rare lethal disease about which little is known. Diagnosis is confined to a narrow period and requires echocardiographic evidence of left ventricular systolic dysfunction. Symptomatic patients should receive standard therapy for heart failure, managed by a multidisciplinary team. If subsequent pregnancies occur, they should be managed in collaboration with a high-risk perinatal center. Systematic data collection is required to answer important questions about incidence, treatment, and prognosis.

Contribution of cardiac MRI in the comprehension of peripartum cardiomyopathy pathogenesis

“…PPC is a rare affection, defined on the basis of 4 criteria: 1-development of cardiac heart failure in the last month of pregnancy or within 5 months after delivery, 2-absence of identifiable cause for the cardiac failure, 3-absence of recognizable heart disease prior to the last month of pregnancy, 4-left ventricular systolic dysfunction demonstrated by classic echocardiographic criteria [2]. Many hypotheses are proposed to explain the occurrence of PPC [1][2][3], and several are based on viral genomic material analysis and histology of endomyocardial tissue.…”

“…Many hypotheses are proposed to explain the occurrence of PPC [1][2][3], and several are based on viral genomic material analysis and histology of endomyocardial tissue. Thus, a "myocarditis-like" mechanism is often proposed, because of a dense lymphocyte infiltrate with myocyte oedema, necrosis and fibrosis on the tissue.…”

“…Several hypotheses are proposed to explain the occurrence of peripartum cardiomyopathy (PPC), including myocarditis, auto-immune mechanisms, apoptosis or other infections [1][2][3]. However, to our knowledge, the usefulness of cardiac magnetic resonance imaging (MRI) has never been reported in comprehension of the mechanism(s) involved in this cardiomyopathy.…”

Fulminant peripartum cardiomyopathy rescue with extracorporeal membranous oxygenation

“…3 The incidence is between 1:3000 and 1:4000 live births but geographical variation is recognised with focal areas of high incidence. 4 Risk factors are unclear. Mortality is reported to vary from 20-80% with 50% of surviving patients recovering to baseline LV function.…”

Pregnancy and peripartum cardiomyopathy: a comparative and prospective study

“…Its incidence is related to the peripartum period. Hypotheses of its cause are focused on the physiologic relationship between pregnancy and the postpartum period and infective genetic disorders and hormonal and metabolic changes [1][2][3] . The criteria for diagnosis of peripartum cardiomyopathy include heart failure in the last month of pregnancy or within the first 5 postpartum months, in the absence of a determinable cause of cardiac failure or the absence of demonstrable preexisting heart disease 4 , and systolic dysfunction confirmed by a lower ejection fraction (EF) or the left ventricular fractional shortening, or both of these, shown by echocardiographic measurement 5 .…”