Risk of heart failure relapse in subsequent pregnancy among peripartum cardiomyopathy mothers

Fett, James D.; Fristoe, Karie L.; Welsh, Serena N.

doi:10.1016/j.ijgo.2009.10.011

Cited by 107 publications

(68 citation statements)

References 16 publications

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“…Further studies are needed in order to better identify risk of relapse. The use of treadmill stress echocardiography to assess contractile reserve has been suggested [48] but has not been sufficiently tested [46••].…”

Section: Peripartum Cardiomyopathymentioning

confidence: 99%

Pregnancy and Heart Disease Updates: Current Knowledge and Future Directions

Davis

2015

Curr Cardiovasc Risk Rep

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Cardiovascular disease is the leading cause of death among pregnant women and causes significant maternal and fetal morbidity. Pregnant women may have known cardiac disease, such as prosthetic heart valves, while others develop new complications, such as myocardial ischemia or cardiomyopathy. Tools for predicting the risk of adverse cardiac events during pregnancy exist. Data from international registries will improve our ability to accurately assess risks and manage and counsel patients. This review will also address the following: (1) Myocardial infarctions that occur during or after pregnancy are often related to coronary dissection and require special attention.(2) Peripartum cardiomyopathy causes heart failure, which can be severe and fatal. Women who recover need careful counseling about the risks of a subsequent pregnancy. (3) Anti-coagulation of mechanical heart valves during pregnancy involves challenging decisions about the safety of warfarin for the fetus, but lowmolecular-weight heparin requires meticulous attention to anti-Xa levels.

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Section: Peripartum Cardiomyopathymentioning

confidence: 99%

Pregnancy and Heart Disease Updates: Current Knowledge and Future Directions

Davis

2015

Curr Cardiovasc Risk Rep

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“…Les patientes ayant complètement normalisé leur FEVG et ayant une réserve contractile satisfaisante lors d'une échographie de stress ne récidivent pas, alors que celles ayant une FEVG inférieure à 45 % récidivent dans près de 67 % des cas. Ce second épisode sera d'autant moins bien toléré que la récupération est partielle [26]. Sauf en cas de récupération complète, une nouvelle grossesse est contreindiquée [2].…”

Section: Pronosticunclassified

Complications cardiovasculaires de la grossesse et du peripartum

Benzidi

Jourdain

2015

Réanimation

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La mortalité maternelle en rapport avec une maladie cardiovasculaire est en augmentation. La grossesse s'accompagne de modifications physiologiques propices à la survenue de la décompensation d'une cardiopathie préexistante, mais peut également être responsable de pathologies acquises de novo. La prise en charge de cardiopathies connues comme les cardiopathies congénitales est fréquente, mais s'accompagne rarement d'un événement grave. Au contraire, les pathologies survenant de novo sont moins fréquentes mais responsables de la majorité des décès. Les principales causes de décès sont la mort subite, l'infarctus du myocarde, la dissection aortique et les cardiomyopathies acquises, en premier lieu desquelles la cardiomyopathie du peripartum. En l'absence d'une prise en charge adéquate, ces pathologies peuvent avoir une évolution rapidement fatale. Leur reconnaissance précoce est donc primordiale, car elle conditionne leur pronostic. Au cours de la prise en charge d'une pathologie cardiovasculaire en réanimation, le pronostic maternel est toujours privilégié par rapport à celui du foetus. La complexité des situations médicales et la dualité mère-enfant rendent indispensables la coordination multidisciplinaire. Mots clés Grossesse · Peripartum · Cardiomyopathie · Traitement · PronosticAbstract Maternal mortality in women with cardiovascular disease is increasing. Pregnancy induces physiological changes resulting in possible decompensation of a preexisting heart disease. However, it could also be associated with a new-onset cardiovascular disease. The treatment of preexisting diseases, such as congenital cardiopathies is common, but is associated with good prognosis. At the opposite, acquired diseases are less common, but responsible for most of deaths. The most common causes of death are sudden arrhythmic death syndrome, myocardial infarction, aortic dissection, amniotic fluid embolism and acquired cardiomyopathies like peripartum cardiomyopathy. Without appropriate treatment, evolution of these pathologies is rapidly fatal. Early diagnosis is essential to improve their prognosis. During the care for the critically ill pregnant, advantage is always given to the maternal prognosis compared to the fetal one. The complexity of care and the duality mother children require a multidisciplinary approach.

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“…Serum brain natriuretic peptide (BNP) level was also markedly elevated (1480.3 pg/ml) at 15 weeks gestation. Transthoracic echocardiogram (TTE) demonstrated preserved left ventricular (LV) ejection fraction (LVEF) (59%) with LV dilation and mild pericardial effusion, but did not fit the criteria for PACM (LVEF b 45 [2,5] Because the risk of exacerbated heart failure was estimated to be high with a low likelihood of a live birth, dilation and evacuation for termination of pregnancy was performed under general anesthesia. As bleeding was excessive (2400 g) during the operation, she required 6 units of red blood cell transfusion.…”

mentioning

confidence: 99%

“…TTE demonstrated a reduced LVEF of 29% with emerging, moderate mitral regurgitation and mild tricuspid regurgitation. Her clinical profile fitted the criteria for PACM (LVEF b 45% [2,5] or b 50% [3]). Her BNP level increased to 1983.8 pg/ml.…”

mentioning

confidence: 99%