Geburtshilfe: die peripartale Kardiomyopathie

Zusammenfassung

Die peripartale Kardiomyopathie (PPCM) ist eine idiopathische Herzinsuffizienz mit Auftreten gegen Ende der Schwangerschaft und in den Monaten postpartal. Andere Ursachen müssen ausgeschlossen sein. Der aktuelle Wissensstand zur PPCM wird anhand eines Mini-Literatur-Reviews aufgearbeitet. Besonderes Augenmerk gilt dem peripartalen anästhesiologischen Management sowie dem Fall einer akuten respiratorischen Insuffizienz nach erfolgter Sectio caesarea im Rahmen einer PPCM mit schwer reduzierter linksventrikulärer Funktion und linksführender kardialer Dekompensation.

Die peripartale Kardiomyopathie ist ein seltenes Krankheitsbild, welches durch Zeichen der Herzinsuffizienz im Rahmen einer linksventrikulären Dysfunktion am Ende der Schwangerschaft und in den Monaten danach gekennzeichnet ist. Die Berührungspunkte mit der Anästhesie und Intensivmedizin können vielseitig sein. Häufig wird die Diagnose erst post partum gestellt.

Abstract

The peripartum cardiomyopathy (PPCM) is an idiopathic heart failure secondary to left-ventricular dysfunction occuring at the end of pregnancy or in the months after delivery. Other causes for heart failure must not exist. The current state of knowledge about PPCM, based on a mini-literature-review, will be presented. We will focus on peripartal anaesthesiologic management and the case of a patient with respiratory insufficiency and lung edema secondary to PPCM.

Schlüsselwörter

Peripartale Kardiomyopathie - PPCM - Anästhesie - Herzinsuffizienz - Schwangerschaft

Key words

peripartum cardiomyopathy - PPCM - anaesthesiology - heart failure - pregnancy

• Literatur

• 1 Gouley B, McMillan T, Bellet S. Idiopathic myocardial degeneration associated with pregnancy and especially the puerperium. Am J Med Sci 1937; 19: 185-199
• 2 Demakis JG, Rahimtoola SH. Peripartum cardiomyopathy. Circulation 1971; 44: 964-968
• 3 Pearson GD, Veille JC, Rahimtoola S. et al. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. J Am Med Assoc 2000; 283: 1183-1188
• 4 Hibbard JU, Lindheimer M, Lang RM. A modified definition for peripartum cardiomyopathy and prognosis based on echocardiography. Obstet Gynecol 1999; 94: 311-316
• 5 Sliwa K, Hilfiker-Kleiner D, Petrie MC. et al. Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail 2010; 12: 767-778
• 6 Biteker M, Kayatas K, Duman D. et al. Peripartum cardiomyopathy: current state of knowledge, new developments and future directions. Curr Cardiol Rev 2014; 10: 317-326
• 7 Elkayam U, Akhter MW, Singh H. et al. Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation 2005; 111: 2050-2055
• 8 Hilfiker-Kleiner D, Haghikia A, Nonhoff J. et al. Peripartum cardiomyopathy: current management and future perspectives. Eur Heart J 2015; 36: 1090-1097
• 9 Elkayam U. Clinical characteristics of peripartum cardiomyopathy in the United States: diagnosis, prognosis, and management. J Am Coll Cardiol 2011; 58: 659-670
• 10 Sliwa K, Mayosi BM. Recent advances in the epidemiology, pathogenesis and prognosis of acute heart failure and cardiomyopathy in Africa. Heart 2013; 99: 1317-1322
• 11 Gentry MB, Dias JK, Luis A. et al. African-American women have a higher risk for developing peripartum cardiomyopathy. J Am Coll Cardiol 2010; 55: 654-659
• 12 Hilfiker-Kleiner D, Schieffer E, Meyer GP. et al. Postpartum cardiomyopathy: a cardiac emergency for gynecologists, general practitioners, internists, pulmonologists, and cardiologists. Dtsch Arztebl Int 2008; 105: 751-756
• 13 Haghikia A, Podewski E, Libhaber E. et al. Phenotyping and outcome on contemporary management in a German cohort of patients with peripartum cardiomyopathy. Basic Res Cardiol 2013; 108: 366
• 14 Sliwa K, Hilfiker-Kleiner D, Mebazaa A. et al. EURObservational Research Programme: a worldwide registry on peripartum cardiomyopathy (PPCM) in conjunction with the Heart Failure Association of the European Society of Cardiology Working Group on PPCM. Eur J Heart Fail 2014; 16: 583-591
• 15 Bello N, Rendon IS, Arany Z. The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. J Am Coll Cardiol 2013; 62: 1715-1723
• 16 Ntusi NB, Mayosi BM. Aetiology and risk factors of peripartum cardiomyopathy: a systematic review. Int J Cardiol 2009; 131: 168-179
• 17 Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet 2006; 368: 687-693
• 18 Hilfiker-Kleiner D, Kaminski K, Podewski E. et al. A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell 2007; 128: 589-600
• 19 Sliwa K, Blauwet L, Tibazarwa K. et al. Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. Circulation 2010; 121: 1465-1473
• 20 Lasinska-Kowara M, Dudziak M, Suchorzewska J. Two cases of postpartum cardiomyopathy initially misdiagnosed for pulmonary embolism. Can J Anaesth 2001; 48: 773-777
• 21 Hu CL, Li YB, Zou YG. et al. Troponin T measurement can predict persistent left ventricular dysfunction in peripartum cardiomyopathy. Heart 2007; 93: 488-490
• 22 Fett JD, Dowell DL, Carraway RD. et al. One hundred cases of peripartum cardiomyopathy… and counting: what is going on?. Int J Cardiol 2004; 97: 571-573
• 23 Regitz-Zagrosek V, Gohlke-Barwolf C, Geibel-Zehender A. et al. [Heart diseases in pregnancy]. Clin Res Cardiol 2008; 97: 630-665
• 24 McMurray JJ, Adamopoulos S, Anker SD. et al. ESC Committee for Practice Guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012; 14: 803-869
• 25 Biteker M, Duran NE, Kaya H. et al. Effect of levosimendan and predictors of recovery in patients with peripartum cardiomyopathy, a randomized clinical trial. Clin Res Cardiol 2011; 100: 571-577
• 26 Bouabdallaoui N, Mouquet F, Lebreton G. et al. Current knowledge and recent development on management of peripartum cardiomyopathy. Eur Heart J Acute Cardiovasc Care 2015;
• 27 Ballo P, Betti I, Mangialavori G. et al. Peripartum cardiomyopathy presenting with predominant left ventricular diastolic dysfunction: efficacy of bromocriptine. Case Rep Med 2012; 2012: 476903
• 28 Haghikia A, Podewski E, Berliner D. et al. Rationale and design of a randomized, controlled multicentre clinical trial to evaluate the effect of bromocriptine on left ventricular function in women with peripartum cardiomyopathy. Clin Res Cardiol 2015; 104: 911-917
• 29 Bernard N, Jantzem H, Becker M. et al. French Network of Regional Pharmacovigilance Centres. Severe adverse effects of bromocriptine in lactation inhibition: a pharmacovigilance survey. BJOG 2015; 122: 1244-1251
• 30 Cunningham C, Rivera J, Spence D. Severe preeclampsia, pulmonary edema, and peripartum cardiomyopathy in a primigravida patient. AANA J 2011; 79: 249-255
• 31 Loser B, Tank S, Hillebrand G. et al. [Peripartum cardiomyopathy: interdisciplinary challenge]. Anaesthesist 2013; 62: 343-354
• 32 Zeng H, Li XX, Zhao WQ. et al. [Anesthesia for caesarean section in a gravida with peripartum cardiomyopathy combined with acute heart failure: a case report]. Beijing Da Xue Xue Bao 2012; 44: 804-807
• 33 Lata S, Prakash MV, Balachander H. Emergency cesarean section in peripartum cardiomyopathy. Anesth Essays Res 2012; 6: 91-93
• 34 Gong TK, Kim SS. Combined epidural anesthesia and ultrasound guided peripheral nerve block for wound revision in a patient with peripartum cardiomyopathy – A case report. Korean J Anesthesiol 2010; 59: 353-358
• 35 Dutt A, Agarwal A, Chatterji R. et al. Anesthetic management for caesarean section in a case of peripartum cardiomyopathy. Anesth Essays Res 2013; 7: 273-275
• 36 Bhakta P, Mishra P, Bakshi A. et al. Case report and mini literature review: anesthetic management for severe peripartum cardiomyopathy complicated with preeclampsia using sufetanil in combined spinal epidural anesthesia. Yonsei Med J 2011; 52: 1-12
• 37 Sumikura H, Hamada T, Idei M. [Anesthetic management of parturients with peripartum cardiomyopathy]. Masui 2014; 63: 31-38
• 38 Osinaike B, Ogah J. Anaesthesia for emergency Caesarean section in a patient with peripartum cardiomypathy. Cardiovasc J Afr 2011; 22: 337-340
• 39 Albani A, Renghi A, Ciarlo M. et al. [Peridural anesthesia versus subarachnoid anesthesia in cesarean section. Prospective clinical study]. Minerva Anestesiol 1998; 64: 387-391
• 40 Beye MD, Ka-Sall B, Diouf E. et al. [Spinal anaesthesia for cesarean section: rate and management of complications in 110 Senegalese parturients]. Dakar Med 2002; 47: 244-246
• 41 Brenck F, Hartmann B, Katzer C. et al. Hypotension after spinal anesthesia for cesarean section: identification of risk factors using an anesthesia information management system. J Clin Monit Comput 2009; 23: 85-92
• 42 Chinachoti T, Tritrakarn T. Prospective study of hypotension and bradycardia during spinal anesthesia with bupivacaine: incidence and risk factors, part two. J Med Assoc Thai 2007; 90: 492-501
• 43 Hsu YC, Huang ST, Ho ST. et al. An unusual case of peripartum cardiomyopathy in a parturient with preeclampsia. Acta Anaesthesiol Taiwan 2010; 48: 33-36