Fennira S, Demiraj A, Khouaja A, Boujnah M R
Service de Cardiologie et Angiologie, CHU Mongi-Slim, Tunisie.
Ann Cardiol Angeiol (Paris). 2006 Oct;55(5):271-5. doi: 10.1016/j.ancard.2005.11.001.
Peripartum cardiomyopathy is a rare and under recognized form of dilated cardiomyopathy, defined as a heart failure in the last month of pregnancy or in the first five months post-partum with absence of determinable cause for cardiac failure and absence of demonstrable heart disease. The incidence of peripartum cardiomyopathy ranges from 1 in 1300 to 1 in 15,000 pregnancy. Advanced maternal age, multiparity, twin births, preeclampsia and black race are known risk factors. The etiology of peripartum cardiomyopathy remains unknown but viral, autoimmune or idiopathic myocarditis are highly suggested. The clinical presentation on patients with peripartum cardiomyopathy is similar to that of patients with systolic heart failure. The treatment is based on drugs for sympyomatic control. Studies in graeter populations are need to determine the role of immunosupressive treatment. About half patients of peripartum cardiomyopathy recover. The left ventricular ejection fraction and the left ventricular end-diastolic diameter are statistically significant prognostic factors. The risk of developing peripartum cardiomyopathy in subsequent pregnancies remains high. The place of dobutamine stress test in counseling the patients who desire pregnancy must be more studied.
围产期心肌病是一种罕见且未得到充分认识的扩张型心肌病，定义为在妊娠最后一个月或产后前五个月出现心力衰竭，且无明确的心力衰竭病因及无明显的心脏病证据。围产期心肌病的发病率在每1300至15000次妊娠中有1例。高龄产妇、多胎妊娠、双胎分娩、先兆子痫和黑人种族是已知的危险因素。围产期心肌病的病因尚不清楚，但强烈提示为病毒、自身免疫或特发性心肌炎。围产期心肌病患者的临床表现与收缩性心力衰竭患者相似。治疗基于对症控制的药物。需要在更大规模人群中进行研究以确定免疫抑制治疗的作用。约一半的围产期心肌病患者可康复。左心室射血分数和左心室舒张末期直径是具有统计学意义的预后因素。后续妊娠发生围产期心肌病的风险仍然很高。多巴酚丁胺负荷试验在为有妊娠意愿的患者提供咨询中的作用必须进一步研究。
