[Post-partum cardiomyopathy: medical aspects, role of heart transplantation].
The incidence of post-partum cardiomyopathies (PPCM) represents 5% of all cardiomyopathies and 10-13% of cardiomyopathies in women. The outcome of PPCM may be: a) death in the acute phase, b) evolution to chronic myocardial disease or c) complete recovery, in which PPCM differs from dilated cardiomyopathy. Another difference is that PPCM may not recur in subsequent pregnancies. The aetiology and pathogenesis of PPCM are still unknown. Infectious diseases, nutritional disorders have been reported but they do not account for the majority of cases. Immune responses to the foreign tissue of the placenta and foetus may explain alteration of immune function associated with myocardial lesion. In the author's experience, the most common pathogenic mechanism is latent myocardial insufficiency observed in each woman in the normal post-partum period. The different noted "causes" could be factors which reveal this latent common condition. Recently, cardiac transplants for PPCM have been reported. As patients with PPCM may recover completely, we believe that PPCM is not a special priority for transplantation. Two recent studies have compared the outcome of women undergoing transplantation for PPCM and those for dilated cardiomyopathy. The risk of rejection and infection was greater in PPCM (but the difference was significant in only one report). The long-term survival was favourable in both groups.
Bertrand
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Service de Médecine, hôpital Nord, Marseille.
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011379:Prognosis; D011644:Puerperal Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012008:Recurrence; D012307:Risk Factors
Myocardiopathie du post-partum: aspects médicaux, place de la transplantation.