Abstract：
There are several causes of heart failure during pregnancy and the peripartum period, which include peripartum cardiomyopathy, Takotsubo cardiomyopathy or stress cardiomyopathy, exacerbation of a preexisting cardiomyopathy, and acute myocarditis. It is important to determine the cause of the heart failure as the medical treatment may be different based on the diagnosis. However, it has been sometimes challenging to diagnose the cause because of the limited diagnostic tools, especially in pregnant women. Cardiac MRI can characterize myocardial injury and can be used to track the changes in myocardial tissue. We herein report a 35-year-old woman diagnosed with peripartum mid-ventricular-type Takotsubo cardiomyopathy, who was referred to our hospital due to worsening dyspnea the day after cesarean delivery. On admission, electrocardiography showed sinus tachycardia and poor progression of R waves in the precordial leads. Bedside echocardiography revealed severe hypokinesis in the mid- and apical left ventricle (LV) with a LV ejection fraction of 20%. Cardiac catheterization showed normal coronary arteries, and myocardial biopsy revealed contraction band necrosis. On acute phase (Day 4), cardiac MRI showed prolonged native T1 and T2, and severe hypokinesis and decreased regional longitudinal peak strain in the mid-anterior LV wall. During the 1st week, precordial ST fluctuation was observed, and LV wall motion had gradually recovered. Repeat cardiac MRI revealed normalized LV wall motion and shortened values for global native T1 and T2. Thus, she was diagnosed with peripartum Takotsubo cardiomyopathy. Serial cardiac MRI may be able to differentiate Takotsubo cardiomyopathy during pregnancy and the peripartum period from other preexisting cardiomyopathies.
摘要：
怀孕期间和围产期有几种心力衰竭的原因，其中包括围产期心肌病，Takotsubo心肌病或应激性心肌病，预先存在的心肌病恶化，和急性心肌炎.确定心力衰竭的原因很重要，因为根据诊断，药物治疗可能会有所不同。然而,由于诊断工具有限，有时很难诊断病因，尤其是孕妇。心脏MRI可以表征心肌损伤，并可用于跟踪心肌组织的变化。我们在此报告一名35岁的女性，被诊断为围产期中期心室型Takotsubo心肌病，他因剖宫产后第二天呼吸困难恶化而被转诊到我们医院。一入场,心电图显示窦性心动过速和心前导联R波进展不良。床旁超声心动图显示左心室中和心尖部（LV）严重运动功能减退，LV射血分数为20％。心导管检查显示冠状动脉正常,心肌活检显示收缩带坏死。在急性期（第4天），心脏MRI显示左心室中前壁的固有T1和T2延长，严重的运动功能减退和区域纵向峰值应变降低。在第一周，观察到心前ST波动，左心室壁运动逐渐恢复。重复心脏MRI显示出标准化的LV壁运动，并缩短了全局天然T1和T2的值。因此，她被诊断为围产期Takotsubo心肌病.连续心脏MRI可能能够区分妊娠和围产期的Takotsubo心肌病与其他先前存在的心肌病。
