Miocardiopatía periparto/Peripartum cardiomyopathy

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Miocardiopatía periparto Miocardiopatía periparto Diego Felipe Polanía Ardila, Solón Navarrete Hurtado, Edgar Mariano Acuña Osorio, Rafael Alberto Álvarez Rosero. Rev Insuf Cardíaca 2009; (Vol 4) 4:177-183  La miocardiopatía periparto no es una patología frecuente; sin embargo, presenta una alta tasa de mortalidad, elevándose aún más cuando el diagnóstico y el tratamiento no se realizan en forma temprana1,2. Las primeras descripciones de la entidad se realizaron alrededor de la década de 1870, cuando Virchow y Porack describieron un proceso de degeneración miocárdica en pacientes quienes fallecieron en el período postparto. Sin embargo, no fue sino hasta el año 1973 cuando se describe que la causa de la falla cardíaca en las pacientes con estas características se debía a una cardiopatía dilatada, diferente de la cardiopatía generada por el estrés del embarazo. Desde ese momento, se reconoce a la miocardiopatía periparto como una entidad distinta del resto de las cardiomiopatías. El propósito de esta revisión es principalmente realizar una descripción de los mecanismos involucrados en la fisiopatología, las manifestaciones clínicas, el diagnóstico y el tratamiento de la enfermedad. http://www.scielo.org.ar/pdf/ic/v4n4/v4n4a06.pdf   Cardiomiopatía periparto: experiencia en un centro terciario Asiático  Peripartum cardiomyopathy: experience in an Asian tertiary centre. Lim CP, Sim KL. National Heart Centre Singapore, 17 Third Hospital Avenue, Singapore 168752. lim.choon.pin@nhcs.com.sg. Singapore Med J. 2013 Jan;54(1):24-7. Abstract Introduction: Peripartum cardiomyopathy (PPCM) is a rare but life-threatening condition. We report 11 patients admitted to the National Heart Centre Singapore with a diagnosis of PPCM over a period of 14 months. Methods: Baseline demographics, pregnancy history, haematology, serum biochemistry and echocardiographic findings of women admitted with a diagnosis of PPCM were analysed. Results: The incidence of PPCM was 0.89 per 1,000 live births in our cohort. 63.6% of the patients were Malay and 27.3% were Chinese. 45.5% of the patients were smokers and 45.5% had a history of pregnancy-induced hypertension or preeclampsia. There was no maternal mortality. Mean left ventricular ejection fractions at diagnosis and at six months were 26.9% ± 9.1% and 51.9% ± 10.6%, respectively. Mean left ventricular internal diameters in end-diastole at diagnosis and at six months were 5.5 ± 0.5 cm and 5.1 ± 0.6 cm, respectively. All patients were treated successfully for the acute episode and all but one patient had returned to New York Heart Association functional class I status at six months. Conclusion: PPCM remains a rare condition and appears to occur more commonly in Malay patients. Smoking and pregnancy-induced hypertension appear to be significant risk factors. While short-term outcome remains excellent, collaborative studies with other tertiary centres will help enhance our understanding of the long-term management of and clinical outcomes in these patients. http://www.sma.org.sg/UploadedImg/files/SMJ/5401/5401a1.pdf      Evolución favorable despues de cardiomiopatía periparto: estudios de 10 años sobre miocardiopatía periparto en un hospital universitario  Favourable outcome after peripartum cardiomyopathy: a ten-year study on peripartum cardiomyopathy in a university hospital. Chee KH. Department of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia. cheekh@um.edu.my. Singapore Med J. 2013 Jan;54(1):28-31. Abstract Introduction: Peripartum cardiomyopathy (PPCM) is an uncommon form of congestive heart failure, affecting obstetric patients around the time of delivery. The epidemiology of PPCM is infrequently reported. This study was undertaken to define the prevalence, presentation and outcome of PPCM among women giving birth in a teaching hospital in Malaysia. Methods: A retrospective case record analysis was conducted on all patients admitted and diagnosed with PPCM at the University Malaya Medical Centre, Kuala Lumpur, Malaysia, from 1 January 2000 to 31 December 2009. All deliveries were undertaken in the same hospital. Results: A total of 12 patients were diagnosed with PPCM during the ten-year study period. The prevalence of PPCM was 2.48 in 100,000 (1 in 40,322) live births. Nine women were diagnosed with PPCM within five months of delivery. Three women had twin pregnancies. There was one death in the group (mortality rate 8.3%). The mean left ventricular ejection fraction at the time of diagnosis was 28.9% ± 8.5% (range 15%-40%). Following the index event, left ventricular function normalised in six of the nine patients (66.7%) who underwent subsequent echocardiography one year later. All patients were treated with standard heart failure therapy. Two patients with normalised left ventricular function had subsequent pregnancies - one pregnancy was terminated at seven weeks and the other patient delivered uneventfully at full term. Conclusion: PPCM is uncommon. The outcome in our series was favourable, with 66.7% of patients with PPCM recovering their left ventricular function. The mortality rate was 8.3%. http://www.sma.org.sg/UploadedImg/files/SMJ/5401/5401a2.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org