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Govsyeyev N, Malgor RD, Hoffman C, Sturman E, Siada S, Al-Musawi M, Malgor EA, Jacobs DL, Nehler M. A systematic review of diagnosis and treatment of acute limb ischemia during pregnancy and postpartum period. J Vasc Surg 2020; 72:1793-1801.e1. [DOI: 10.1016/j.jvs.2020.04.516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/23/2020] [Indexed: 01/01/2023]
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Yaméogo NV, Kaboré E, Seghda A, Kagambèga LJ, Kaboré HP, Millogo GRC, Kologo KJ, Kambiré Y, Bama A, Toguyeni BJY, Samadoulougou AK, Zabsonré P. [Severe pulmonary embolism and acute lower limb ischemia complicating peripartum cardiomyopathy successfully treated by streptokinase]. Ann Cardiol Angeiol (Paris) 2016; 65:38-41. [PMID: 25623958 DOI: 10.1016/j.ancard.2014.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 05/25/2014] [Indexed: 06/04/2023]
Abstract
Peripartum cardiomyopathy is a cardiac disease at high thromboembolism potential. The authors report a case of peripartum cardiomyopathy admitted for congestive heart failure. Echocardiography found a dilated cardiomyopathy with severely impaired left ventricular systolic function and biventricular thrombi. During hospitalization his condition was complicated by severe bilateral pulmonary embolism and left lower limb arterial acute thrombosis. The treatment consisted of thrombolysis with streptokinase associated with dobutamine (in addition to the conventional treatment of heart failure and bromocriptine). The outcome was favorable, marked by pulmonary and lower limb arterial unblocking.
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Affiliation(s)
- N V Yaméogo
- Service de cardiologie, centre hospitalier universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso.
| | - E Kaboré
- Service de cardiologie, centre hospitalier universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - A Seghda
- Service de cardiologie, centre hospitalier universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - L J Kagambèga
- Service de cardiologie, centre hospitalier universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - H P Kaboré
- Service de cardiologie, centre hospitalier universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - G R C Millogo
- Service de cardiologie, centre hospitalier universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - K J Kologo
- Service de cardiologie, centre hospitalier universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - Y Kambiré
- Service de cardiologie, Hôpital national Blaise Compaoré, 03 BP, 7027 Ouagadougou 03, Burkina Faso
| | - A Bama
- Service de médecine, centre hospitalier universitaire pédiatrique Charles De Gaule, 03 BP, 1198 Ouagadougou 03, Burkina Faso
| | - B J Y Toguyeni
- Service de cardiologie, centre hospitalier universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - A K Samadoulougou
- Service de cardiologie, centre hospitalier universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - P Zabsonré
- Service de cardiologie, centre hospitalier universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
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Pio M, Afassinou Y, Baragou S, Akue EG, Péssinaba S, Atta B, Ehlan K, Alate A, Damorou F. [Special features of peripartum cardiomyopathy in Africa: the case of Togo on a prospective study of 41 cases at Sylvanus Olympio University Hospital of Lome]. Pan Afr Med J 2014; 17:245. [PMID: 25309645 PMCID: PMC4189861 DOI: 10.11604/pamj.2014.17.245.3058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 03/06/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction La cardiomyopathie du péripartum (CMPP) est une défaillance cardiaque dont l’étiologie demeure encore méconnue. Méthodes Il s'agit d'une étude prospective descriptive réalisée dans le service de cardiologie du CHU Sylvanus olympio de Lomé du 1er janvier 2010 au 30 avril 2012. Elle a concerné 41 patientes ayant présenté une insuffisance cardiaque entre le 8eme mois de la grossesse et les 5 premiers mois du post-partum. Résultats L’âge moyen des patientes était de 31,47 ans (extrêmes 21 et 44ans). L'incidence de la CMPP était de 1/362 grossesses. La parité moyenne était de 3,07 (extrêmes 1 et 6). Les symptômes étaient apparus dans le post-partum dans 90,24% des cas. Un retard important de diagnostic était observé. L'insuffisance cardiaque globale était le mode de décompensation dans 65,85%. Les signes électrocardiographiques étaient essentiellement la tachycardie sinusale (97,56%) et l'hypertrophie ventriculaire gauche (97,56%). L’échographie cardiaque a montré dans tous les cas une cardiomyopathie dilatée. Quatre cas de thrombus intraventriculaire gauche étaient notés. La FEVG était sévèrement altérée. L'HTAP était importante dans 56,09%. Conclusion La cardiomyopathie du péripartum est une complication cardiaque grave de la grossesse de cause inconnue, fréquente dans la population africaine.
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Affiliation(s)
- Machihude Pio
- Service de Cardiologie, Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO) de Lomé
| | - Yaovi Afassinou
- Service de Cardiologie, Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO) de Lomé
| | - Soodougoua Baragou
- Service de Cardiologie. Centre Hospitalier Universitaire Campus de Lomé, Togo
| | - Edem Goeh Akue
- Service de Cardiologie, Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO) de Lomé
| | | | - Borgatia Atta
- Service de Cardiologie, Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO) de Lomé
| | - Koffi Ehlan
- Service de Cardiologie, Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO) de Lomé
| | - Amouzou Alate
- Service de Cardiologie, Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO) de Lomé
| | - Findibe Damorou
- Service de Cardiologie. Centre Hospitalier Universitaire Campus de Lomé, Togo
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Carlin AJ, Alfirevic Z, Gyte GML. Interventions for treating peripartum cardiomyopathy to improve outcomes for women and babies. Cochrane Database Syst Rev 2010:CD008589. [PMID: 20824881 PMCID: PMC4170903 DOI: 10.1002/14651858.cd008589.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM or PCMO) is a rare disease of unknown etiology, characterised by an acute onset of heart failure in women in the late stage of pregnancy or in the early months postpartum. OBJECTIVES To assess the effectiveness and safety of any intervention for the care of women and/or their babies with a diagnosis of peripartum cardiomyopathy. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 July 2010) and the reference lists of identified studies. SELECTION CRITERIA Randomised and quasi-randomised controlled trials of any intervention for treating peripartum cardiomyopathy. Such interventions include: drugs; cardiac monitoring and treatment; haemodynamic monitoring and treatments; supportive therapies and heart transplant. DATA COLLECTION AND ANALYSIS Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data entry was checked. MAIN RESULTS We identified and included one pilot study, involving 20 women, undertaken in South Africa. Women were diagnosed postnatally and included in the study within 24 hours of diagnosis. AUTHORS' CONCLUSIONS There are insufficient data to draw any firm conclusions. Treatment with bromocriptine appears promising, although women would be unable to breastfeed due to suppression of lactation.
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Affiliation(s)
- Andrew J Carlin
- Maternal Fetal Medicine Unit, John Hunter Hospital, New Lambton Heights, Australia
| | - Zarko Alfirevic
- School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, The University of Liverpool, Liverpool, UK
| | - Gillian ML Gyte
- Cochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, The University of Liverpool, Liverpool, UK
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Carlin AJ, Alfirevic Z, Gyte GML. Interventions for treating peripartum cardiomyopathy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Moioli M, Valenzano Menada M, Bentivoglio G, Ferrero S. Peripartum cardiomyopathy. Arch Gynecol Obstet 2009; 281:183-8. [DOI: 10.1007/s00404-009-1170-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
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Selle T, Renger I, Labidi S, Bultmann I, Hilfiker-Kleiner D. Reviewing peripartum cardiomyopathy: current state of knowledge. Future Cardiol 2009; 5:175-89. [DOI: 10.2217/14796678.5.2.175] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a serious, potentially life-threatening heart disease of unknown etiology in previously healthy women that develops between the last month of pregnancy and 5–6 months after delivery. PPCM is a distinct clinical entity in which echocardiography demonstrates the features of an idiopathic dilated cardiomyopathy with a high morbidity and mortality, but in addition, patients suffering with PPCM have a chance of reaching full recovery. A variety of potential risk factors related to PPCM have been suggested over the last decades, which may help to identify women at risk in the future. Recent advances in understanding the pathophysiology of PPCM assign a key role to unbalanced oxidative stress and the generation of a cardiotoxic prolactin subfragment. In this regard, pharmacological blockade of prolactin holds the promise of novel, more disease-specific therapy options. The present article provides an overview on the clinical appearance and management, risk factors and potential pathophysiological mechanisms of PPCM.
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Affiliation(s)
- Tina Selle
- Hannover Medical School (MHH), Department of Cardiology & Agiology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Isabelle Renger
- Hannover Medical School (MHH), Department of Cardiology & Agiology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Saida Labidi
- Hannover Medical School (MHH), Department of Cardiology & Agiology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Insa Bultmann
- Hannover Medical School (MHH), Department of Cardiology & Agiology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Denise Hilfiker-Kleiner
- Hannover Medical School (MHH), Department of Cardiology & Agiology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Bahloul M, Ben Ahmed MN, Laaroussi L, Chtara K, Kallel H, Dammak H, Ksibi H, Samet M, Chelly H, Ben Hamida C, Chaari A, Amouri H, Rekik N, Bouaziz M. [Peripartum cardiomyopathy: incidence, pathogenesis, diagnosis, treatment and prognosis]. ACTA ACUST UNITED AC 2008; 28:44-60. [PMID: 19111432 DOI: 10.1016/j.annfar.2008.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 11/04/2008] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Peripartum cardiomyopathy (PPCM) is a rare and life-threatening disease of unknown aetiology. The primary objective of this review was to analysed aetiopathogeneses, clinical presentation and diagnosis, as well as pharmacological, perioperative and intensive care management and prognosis of this pathology. METHODS We undertook a systematic review of the literature using Medline, Google Scholar and PubMed searches. RESULTS Unlike other parts of the world in which cardiomyopathy are rare, dilated cardiomyopathy is a major cause of heart failure throughout Africa. Its aetiopathogenesis is still poorly understood, but recent evidence supports inflammation, viral infection and autoimmunity as the leading causative hypotheses. This diagnosis should be limited to previously healthy women who present with congestive heart failure (CHF) and decreased left ventricular systolic function in the last month of pregnancy or within 5 months after delivery. Recently, introduction of echocardiography has made diagnosis of PPCM easier and more accurate. Conventional treatment consists of diuretics, vasodilators, and sometimes digoxin and anticoagulants, usually in combination. Patients who fail to recover may require inotropic therapy. In resistant cases, newer therapeutic modalities such as immunomodulation, immunoglobulin and immunosuppression may be considered. Prognosis is highly related to reversal of ventricular dysfunction. Compared to historically higher mortality rates, recent reports describe better outcome, probably because of advances in medical care. Based on current information, future pregnancy is usually not recommended in patients who fail to recover normal heart function. CONCLUSION PPCM is a rare but serious form of cardiac failure affecting women in the last months of pregnancy or early puerperium. Its aetiopathogenesis is still poorly understood. Introduction of echocardiography has made diagnosis of PPCM easier and more accurate. Prognosis is highly related to reversal of ventricular dysfunction.
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Affiliation(s)
- M Bahloul
- Service de réanimation médicale, CHU Habib Bourguiba, route El Ain Km 1, 3029 Sfax, Tunisie.
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Abboud J, Murad Y, Chen-Scarabelli C, Saravolatz L, Scarabelli TM. Peripartum cardiomyopathy: a comprehensive review. Int J Cardiol 2007; 118:295-303. [PMID: 17208320 DOI: 10.1016/j.ijcard.2006.08.005] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Revised: 07/17/2006] [Accepted: 08/03/2006] [Indexed: 01/11/2023]
Abstract
Peripartum cardiomyopathy (PPCM) is a rare disorder in which left ventricular dysfunction and symptoms of heart failure occur in the peripartum period in previously healthy women. Incidence of PPCM ranges from 1 in 1300 to 1 in 15,000 pregnancies. The etiology of PPCM is unknown, but viral, autoimmune, and idiopathic causes may contribute. The diagnostic criteria are onset of heart failure in the last month of pregnancy or in first 5 months postpartum, absence of determinable cause for cardiac failure, and absence of a demonstrable heart disease before the last month of pregnancy. Risk factors for PPCM include advanced maternal age, multiparity, African race, twinning, gestational hypertension, and long-term tocolysis. The clinical presentation of patients with PPCM is similar to that of patients with dilated cardiomyopathy. Early diagnosis and initiation of treatment are essential to optimize pregnancy outcome. Treatment is similar to medical therapy for other forms of dilated cardiomyopathy. About half the patients of PPCM recover without complications. The prognosis is poor in patients with persistent cardiomyopathy. Persistence of disease after 6 months indicates irreversible cardiomyopathy and portends worse survival.
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Affiliation(s)
- John Abboud
- Center for Heart and Vessel Preclinical Studies, Division of Cardiology, St John Hospital and Medical Center, Wayne State University, Detroit, MI 48236, USA
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