PDF(Pubmed)
Abstract：
UNASSIGNED: Prior exposure to cardiotoxic cancer therapies has been associated with an increased risk of peripartum cardiomyopathy (PPCM). The management of PPCM in this population remains a clinical challenge. Few studies have explored the use of mechanical circulatory support in PPCM. We present a case of early implementation of intra-aortic balloon pump (IABP) therapy for acute stabilization and intrapartum support of PPCM.
UNASSIGNED: A 36-year-old G4P2103 (4th pregnancy, two full-term, one premature birth, 0 abortions, and three living children) woman at 26 weeks and 5 days gestation with history of combined peripartum and anthracycline-induced cardiomyopathy [previously left ventricular ejection fraction (LVEF) 10-15% and recently 40-45%] presented with acute decompensated heart failure. Her clinical status deteriorated with a drop in LVEF to 15-20% with a significant increase in pulmonary pressures and worsening mitral regurgitation. A multidisciplinary decision with the cardio-obstetrics team was made to place a pulmonary artery catheter for invasive haemodynamic monitoring and IABP insertion prior to delivery. Intra-aortic balloon pump support had a profound immediate decrease in her systemic and pulmonary vascular resistance allowing for a successful repeat caesarean delivery. Her haemodynamics remained stable after IABP removal and pulmonary pressures improved. She was discharged one week following her delivery on guideline-directed medical therapy.
UNASSIGNED: Our case highlights the use of prophylactic intrapartum IABP in combined anthracycline-induced and PPCM and begins to explore its safety and efficacy in this high-risk patient population.
UNASSIGNED: A 36-year-old G4P2103 (4th pregnancy, two full-term, one premature birth, 0 abortions, and three living children) woman at 26 weeks and 5 days gestation with history of combined peripartum and anthracycline-induced cardiomyopathy [previously left ventricular ejection fraction (LVEF) 10-15% and recently 40-45%] presented with acute decompensated heart failure. Her clinical status deteriorated with a drop in LVEF to 15-20% with a significant increase in pulmonary pressures and worsening mitral regurgitation. A multidisciplinary decision with the cardio-obstetrics team was made to place a pulmonary artery catheter for invasive haemodynamic monitoring and IABP insertion prior to delivery. Intra-aortic balloon pump support had a profound immediate decrease in her systemic and pulmonary vascular resistance allowing for a successful repeat caesarean delivery. Her haemodynamics remained stable after IABP removal and pulmonary pressures improved. She was discharged one week following her delivery on guideline-directed medical therapy.
UNASSIGNED: Our case highlights the use of prophylactic intrapartum IABP in combined anthracycline-induced and PPCM and begins to explore its safety and efficacy in this high-risk patient population.
摘要：
■先前暴露于心脏毒性癌症疗法与围产期心肌病（PPCM）的风险增加有关。该人群中PPCM的管理仍然是临床挑战。很少有研究探索在PPCM中使用机械循环支持。我们介绍了早期实施主动脉内球囊反搏（IABP）治疗以急性稳定和PPCM的产时支持的案例。
■36岁的G4P2103（第四次怀孕，两个完整的任期，一个早产,0次流产,和三个活着的孩子）妊娠26周和5天的女性，有合并围产期和蒽环类抗生素诱发的心肌病的病史[以前的左心室射血分数（LVEF）10-15％，最近的40-45％]出现急性代偿性心力衰竭。她的临床状况恶化，LVEF下降至15-20％，肺压显着增加，二尖瓣反流恶化。与心血管产科团队一起做出了多学科决定，在分娩前放置肺动脉导管以进行有创血流动力学监测和IABP插入。主动脉内球囊泵的支持使她的全身和肺血管阻力立即大大降低，从而成功地重复剖腹产。去除IABP后，她的血流动力学保持稳定，肺压改善。她在接受指南指导的药物治疗后一周出院。
■我们的案例强调了在蒽环类药物联合诱导的PPCM中使用预防性产时IABP，并开始探索其在该高危患者人群中的安全性和有效性。
■36岁的G4P2103（第四次怀孕，两个完整的任期，一个早产,0次流产,和三个活着的孩子）妊娠26周和5天的女性，有合并围产期和蒽环类抗生素诱发的心肌病的病史[以前的左心室射血分数（LVEF）10-15％，最近的40-45％]出现急性代偿性心力衰竭。她的临床状况恶化，LVEF下降至15-20％，肺压显着增加，二尖瓣反流恶化。与心血管产科团队一起做出了多学科决定，在分娩前放置肺动脉导管以进行有创血流动力学监测和IABP插入。主动脉内球囊泵的支持使她的全身和肺血管阻力立即大大降低，从而成功地重复剖腹产。去除IABP后，她的血流动力学保持稳定，肺压改善。她在接受指南指导的药物治疗后一周出院。
■我们的案例强调了在蒽环类药物联合诱导的PPCM中使用预防性产时IABP，并开始探索其在该高危患者人群中的安全性和有效性。
