[Peripartum cardiomyopathy: incidence, pathogenesis, diagnosis, treatment and prognosis].
BACKGROUND
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.


CONCLUSIONS
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.
Bahloul
M
M
Service de réanimation médicale, CHU Habib Bourguiba, route El Ain Km 1, 3029 Sfax, Tunisie. bahloulmab@yahoo.fr
Ben Ahmed
M N
MN
Laaroussi
L
L
Chtara
K
K
Kallel
H
H
Dammak
H
H
Ksibi
H
H
Samet
M
M
Chelly
H
H
Ben Hamida
C
C
Chaari
A
A
Amouri
H
H
Rekik
N
N
Bouaziz
M
M
D000328:Adult; D000367:Age Factors; D009202:Cardiomyopathies / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D003422:Critical Care; D036861:Delivery, Obstetric; D005006:Ethnicity; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D016896:Treatment Outcome; D014416:Tunisia / Q000453:epidemiology; D055815:Young Adult