Hakata Saya, Umegaki Takeshi, Soeda Takehiro, Nishimoto Kota, Ando Akiko, Anada Natsuki, Uba Takeo, Sumi Chisato, Kamibayashi Takahiko
Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
JA Clin Rep. 2019 Jun 7;5(1):38. doi: 10.1186/s40981-019-0256-8.
Peripartum cardiomyopathy is an uncommon form of heart failure that occurs in otherwise healthy women during pregnancy or until 5 months postpartum. Here, we report a rare case where a female patient underwent cesarean section after the occurrence of preeclampsia and intrauterine fetal death, and developed peripartum cardiomyopathy following postsurgical respiratory distress. The prompt initiation of inotropic drug and bromocriptine therapy quickly restored cardiac function.
The patient was a 36-year-old woman who underwent emergency cesarean section for a previous preeclampsia and an intrauterine fetal death that occurred after 24 weeks of pregnancy. In addition, the patient had an extremely low platelet count of 5000/μL on admission. She had been diagnosed as idiopathic thrombocytopenic purpura at the age of 29 years old and treated with prednisolone at 15 mg/day. Therefore, the cesarean section was performed under general anesthesia. The patient did not exhibit respiratory or hemodynamic dysfunction during surgery. However, she developed respiratory distress with sinus tachycardia after extubation and was transferred to the intensive care unit. A chest radiograph showed butterfly shadows, and transthoracic echocardiogram confirmed the reduction of left ventricle contractility (ejection fraction 20%). She was diagnosed with peripartum cardiomyopathy and treated immediately with intravenous milrinone, oral bromocriptine, and angiotensin-converting enzyme inhibitor. Respiratory and hemodynamic function improved rapidly, and the patient was moved to the general ward 2 days after surgery. Fourteen days after surgery, the patient had an ejection fraction of 57%. The patient recovered without any further complications and was discharged 24 days after surgery.
A sudden case of peripartum cardiomyopathy was successfully managed by a prompt diagnosis and treatment with inotropic agents and bromocriptine.
围产期心肌病是一种罕见的心力衰竭形式，发生在孕期或产后5个月内原本健康的女性身上。在此，我们报告一例罕见病例，一名女性患者在发生子痫前期和宫内胎儿死亡后接受了剖宫产手术，并在术后出现呼吸窘迫后发展为围产期心肌病。及时开始使用正性肌力药物和溴隐亭治疗迅速恢复了心脏功能。
该患者为一名36岁女性，因先前的子痫前期和怀孕24周后发生的宫内胎儿死亡接受了急诊剖宫产手术。此外，患者入院时血小板计数极低，为5000/μL。她在29岁时被诊断为特发性血小板减少性紫癜，接受泼尼松龙15mg/天的治疗。因此，剖宫产手术在全身麻醉下进行。患者在手术过程中未出现呼吸或血流动力学功能障碍。然而，拔管后她出现了伴有窦性心动过速的呼吸窘迫，并被转入重症监护病房。胸部X线片显示蝶形阴影，经胸超声心动图证实左心室收缩力降低（射血分数20%）。她被诊断为围产期心肌病，并立即接受静脉注射米力农、口服溴隐亭和血管紧张素转换酶抑制剂治疗。呼吸和血流动力学功能迅速改善，患者在术后2天转至普通病房。术后14天，患者的射血分数为57%。患者康复，无任何进一步并发症，并在术后24天出院。
通过及时诊断并使用正性肌力药物和溴隐亭进行治疗，成功处理了一例围产期心肌病突发病例。
