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Pre-and postpartum heart failure

  • Valvular heart disease, presented by G Sinagra (Trieste, IT) - Slides
  • Pulmonary hypertension, presented by O Sitbon (Clamart, FR) - Slides
  • Grown-up congenital heart disease, presented by M Chessa (San Donato Milanese, IT) - Slides
  • Peripartum cardiomyopathy, presented by D Hilfiker-Kleiner (Hannover, DE) - Slides


Heart Failure (HF)

There is a lack of data on the burden or cardiovascular disease in women of child-bearing age worldwide. Women can have pre-existing heart disease – for example, congenital heart disease, rheumatic heart disease, chronic hypertension - or develop heart failure due to various causes pre-or postpartum. Pregnancy with heart disease is considered high risk and is the leading non-obstetric cause of maternal death, both in the developed and developing countries.

In this session Dr. G Sinagra, Triete, Italy highlighted the complexity of disease management in pregnant women with valvular heart disease. In general the regurgitant lesions are better tolerated than the stenotic lesions. However, each case should ideally have risk assessment even pre-pregnancy and be carefully monitored by a team comprising cardiologist, gynaecologist, anaesthetist and possibly other specialists in the field.

In general, pregnancy should be discouraged in women with diagnosed pulmonary hypertension. Dr. Sitbon from Clamart, France highlighted the fact that the majority cases with poor outcome died within the 14 days postpartum making ICU monitoring mandatory. IVI epoprostenol is ideal in pregnancy but not available everywhere.

Dr. Chessa from Milan, Italy presented data on the complexity of managing pregnancy in women with operated congenital heart disease. A pregnancy in these women has implications on the maternal health as well as fetal outcome, which need to be considered from case to case. As right heart failure with hypotension and subsequent death provides a real threat, Dr. Chessa proposes prophylactic pulmonary valve replacement for moderate to severe pulmonary regurgitation in selected cases. However, whether arrhythmic complications can be avoided by this procedure remains unknown and requires investigation.

Peripartum cardiomyopathy (PPCM) is a serious, potentially life-threatening heart disease of uncertain aetiology in previously healthy women, presenting either shortly before giving birth or within 6 months postpartum. Prof. Denise Hilfiker-Kleiner presented novel data on pathophysiology. While previous clinical and experimental data suggest inflammation, autoimmune processes and apoptosis and as typical features in the pathophysiology of this disease, recent data have shown that unbalanced peri/postpartum oxidative stress is linked to proteolytic cleavage of the nursing hormone prolactin into a potent anti-angiogenic, pro-apoptotic and pro-inflammatory 16-kDa subform. These observations strongly suggest that prolactin cleavage may operate as a specific pathomechanism for the development of PPCM. First clinical experiences with bromocriptine are promising, with respect to prevention or treatment of PPCM in patients. Studies in Germany and Africa to confirm this promising data in larger cohorts are ongoing. The European Society of Cardiology (ESC) has initiated an ESC-wide registry on PPCM which will commence in 2011




Pre-and postpartum heart failure

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.