Peripartum cardiomyopathy: A comprehensive review

Abboud, John; Murad, Yahya; Chen‐Scarabelli, Carol; Saravolatz, Louis; Scarabelli, Tiziano M.

doi:10.1016/j.ijcard.2006.08.005

Cited by 159 publications

(159 citation statements)

References 126 publications

(159 reference statements)

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“…This association is consistent with previous studies, but the literature is unclear if race is an independent risk factor or whether race interacts with hypertension to increase the risk of cardiomyopathy. 7 The parity of the women in this series is comparable with that of the general obstetric population at our centre.…”

Section: Discussionsupporting

confidence: 64%

“…6 Previous studies and reviews have focused largely on the medical and obstetric management of these patients. [7][8][9] Literature on anesthetic management has been limited to individual case reports. [10][11][12] The purpose of this case series was to report on the peripartum anesthetic management and outcomes of women with dilated cardiomyopathy in a large university medical centre.…”

Section: Résumémentioning

confidence: 99%

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Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre

Ituk

Habib

Polin

et al. 2014

Can J Anesth/J Can Anesth

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Purpose This study examines the peripartum anesthetic management and outcomes of women with dilated cardiomyopathy in a large university medical centre over a seven-year period. Principal findings Twenty-five women were included in this series, 18 with a new diagnosis of cardiomyopathy and seven with a history of cardiomyopathy. Sixteen patients (64%) identified themselves as African American, seven (28%) were Caucasian, and two patients (8%) were Hispanic. The median (range) gestational age at the time of a new diagnosis of cardiomyopathy was 29 (7-38) weeks. Eight women (32%) had New York Heart Association class III/IV symptoms at the time of delivery or in the immediate postpartum period. A multidisciplinary team of obstetricians, anesthesiologists, cardiologists, and pediatricians were involved in the care of these women. The median (range) gestational age at the time of delivery was 33.5 (30-40) weeks. There were nine vaginal deliveries and 15 operative deliveries. One patient had fetal loss at 19 weeks gestation. Twelve women had labour induced with an intravenous infusion of oxytocin at a rate of 0.001-0.02 IUÁmin -1 . An oxytocin infusion at a variable rate with a maximum dose of 0.05 IUÁmin -1 was administered after vaginal delivery to maintain uterine tone. Epidural analgesia was initiated prior to induction of labour or in the latent phase of labour. Seven Cesarean deliveries were performed under combined spinal-epidural anesthesia, five were performed under epidural anesthesia, and three women had general anesthesia. Oxytocin was administered via an intravenous infusion at a rate of 0.05-0.2 IUÁmin -1 after operative delivery. One patient had a cardiac arrest on induction of general anesthesia and was successfully resuscitated. There were no maternal or neonatal deaths. Ten women were followed up at our institution and at six months postpartum; 50% of these patients were still symptomatic. Conclusion We report favourable outcomes in 25 pregnant women with dilated cardiomyopathy who were managed by a multidisciplinary team. Résumé

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Section: Discussionsupporting

confidence: 64%

Section: Résumémentioning

confidence: 99%

Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre

Ituk

Habib

Polin

et al. 2014

Can J Anesth/J Can Anesth

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“…Prolactine may also play a role, as has been recently demonstrated in animal studies. [1][2][3][4] Furthermore, autoimmunity and inflammation are potential causative factors, although the incidence of histologically proven myocarditis is variable. Mortality from severe heart failure is reported to be up to 20% in patients with PPCM, with the majority of deaths being sudden.…”

mentioning

confidence: 99%

“…Heart transplantation was performed in 4 to 10%. 1,3 Spontaneous recovery of the left ventricular ejection fraction (LVEF) >50% was seen in 45 to 50% of patients. Recovery of the LVEF is mainly seen in the first two to six months after delivery but can improve over the first year.…”

mentioning

confidence: 99%

“…Recovery of the LVEF is mainly seen in the first two to six months after delivery but can improve over the first year. 1,3 Predictors of complete recovery (EF >50%) are: left ventricular end-diastolic diameter <56 mm, mean left ventricular ejection fraction at two months after delivery >45% and the absence of thrombus in the left ventricle at the time of diagnosis. 2 Medical therapy for PPCM consists mainly of regular heart failure therapy.…”

mentioning

confidence: 99%

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Left ventricular assist device as a bridge to recovery in a young woman admitted with peripartum cardiomyopathy

Oosterom¹,

Jonge²,

Kirkels³

et al. 2008

NHJL

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Left ventricular assist device as a bridge to recovery in a young woman admitted with peripartum cardiomyopathy Left ventricular assist devices (LVAD) are an effective therapeutic option for end-stage heart failure patients as a bridge to cardiac transplantation in those who deteriorate despite maximal therapy and when a donor heart is not ready available. In some patients, cardiac recovery has been reported while supported by an LVAD. In this case report, we describe a 29-year-old female who was admitted to our centre because of peripartum cardiomyopathy (PPCM). Despite intensive treatment with intravenous inotropes and intra-aortic balloon counterpulsation she had a persisting low cardiac index and an LVAD was implanted. In the months following implantation the left ventricular systolic function improved and the left ventricular dimensions normalised. Eventually the LVAD could be explanted nine months after implantation. At this moment, three years after explantation, echocardiography shows a normal-sized left ventricle and almost completely recovered systolic function. (Neth Heart J 2008;16:426-8).

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