Vol.3, No.1, 37-38 (2011)Health doi:10.4236/health.2011.31007
A 29-year-old pregnant woman with a history of anthracycline-induced clinical heart failure
Valentina Scheggi*, Fabio Mori
Department of Cardiology, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy;
*Corresponding Author: ***************************
Received 11 November 2010; revid 2 November 2010; accepted 8 November 2011.
ABSTRACT
The number of women with heart dia who reach childbearing age in a good functional state increas continuously as advances in diagnosis and treatment improve overall health and prognosis. The cardiologist’s role is to give the woman an estimate of both maternal and fetal risk to allow her to make an informed deci-sion about embarking on a pregnancy, and to provide appropriate antenatal care. There are only a few data about the natural history of an-thracycline-induced cardiomyopathy during preg- nancy; we report our experience of a 29-year- old pregnant woman with a history of anthracy-cline-induced clinical heart failure.
Keywords:Anthracyclines; Heart Failure; Pregnancy; Cardiomyopathy
1. INTRODUCTION
Heart dia is prent in 0.5-1% of all pregnancies and accounts for about 10-15% of all maternal death. Management of the patients requires teamwork of ob-stetricians, neonatologists, cardiologists, anesthetists and sometimes cardiac surgeons but there are only a few data in the literature to guide clinicians in maternal and fetal care. We report the ca of a pregnant woman with an-thracycline-induced cardiomyopathy and a review of the literature.
2. METHODS
We evaluated a 29-year-old woman in the 5th week of pregnancy. During childhood she had osteosarcoma treated with anthracyclines and at the age of 25 years she prented anthracycline-induced NYHA class IV heart failure with markedly reduced systolic left ventricular function (EF 24%) and vere mitral regurgitation. She was treated with ACE-inhibitors, beta-blockers and diu-retics with good clinical result and improving systolic left ventricular function with EF until 47% and trivial mitral regurgitation.
At the time of evaluation the pul was 83 bpm, blood pressure was 90/60 mmHg, without signs of heart failure; the electrocardiogram was normal and p-BPN was 600 pg/ml.
The ACE-inhibitor was discontinued and she was treated with bisoprolol and LMWH.
Her clinical conditions and left systolic ventricular function continued to be stable and she vaginally deliv-ered a healthy child at 35 weeks of pregnancy.
The follow up after delivery was uneventful with sta-ble EF.回首过去展望未来
3. DISCUSSION
Mortality among minimally symptomatic pregnant women with cardiac dia is about 1%, as among the healthy general population. In contrast, verely symp-tomatic women have been reported to experience a mor-tality risk up to 5-15%.
Just a small number of parameters allow dichotomic classification into high-risk and low-risk patients.
In a prospective multicentre study enrolling 562 women, Siu et al. [1] identified poor functional NYHA
class or cyanosis, left ventricular systolic dysfunction (EF < 50%), and left heart obstruction as major deter-minants for maternal cardiac complications.
Neonatal complications (20% of pregnancies) were associated with poor functional class or cyanosis, left heart obstruction, anticoagulation, smoking, and multiple gestations.
Verena Stangl et al. [2] found that women at high-risk (as defined above) had a 6.1-fold higher maternal com-plication rate and a 6.1 times higher fetal/neonatal event rate; 64.7% of the high-risk women delivered prema-turely, compared to 16.4% in the low-risk group.
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V. Scheggi et al. / Ntural Science 3 (2011) 37-38 38
In low-risk women, fetal complications were compa-rable to tho reported for the general population but preterm birth rate was slightly higher.
Thorne et al. [3] showed that the risk of maternal death is approximately 7% if the patient is in New York Heart Association (NYHA) functional class III or IV. Other adver risk factors include ejection fraction < 20%, mitral regurgitation, right ventricular failure, atrial fibrillation, and systemic hypotensio
n.
垃圾分类口号The natural history of specific types of cardiomyopa-thy during pregnancy is unknown and there are only a few data about pregnant women with anthracycline-in- duced cardiomyopathy.
Anthracycline-cardiotoxicity can become manifest as either clinical heart failure or asymptomatic cardiac dysfunction. Both can develop also years after the cessa-tion of treatment, as happened in our patient.
Elvira C. van Dalen [4] evaluated the incidence of pe-ripartum anthracycline-induced clinical heart failure in a cohort of 53 women. This study demonstrates a low risk in childhood cancer survivors.
It is worth noticing that 2 of the 53 women included in this study developed heart failure shortly after the end of anthracycline therapy and that neither of them developed any peripartum cardiac problems.
About therapy, sodium and physical activity restric-tions, in association with drugs like digoxin and fu-romide, help control heart failure during pregnancy. Hydralazine, with or without nitrates, is an alternative to angiotensin-converting enzyme inhibitors, that are associated with side effects.
As anti-arrhythmics, amiodarone may be toxic but beta-blockers can be ud safely.
Finally, patients with ventricular dysfunction must be anticoagulated with heparin at prophylactic dos to prevent thromboembolism.
4. CONCLUSION
In summary, pregnancy outcome in women who re-ceived anthracyclines for malignancy in childhood is generally favorable. Tho with left ventricular dysfunc-tion, as our patient, should be considered at incread risk but probably the most important prognostic factor is the NYHA class.
REFERENCES
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[2]Stangl, V., Schad, J., Gossing, G., Borges, A., Baumann,
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朱自清写景散文[3]Thorne, S.A. (2004) Pregnancy in heart dia. Heart,李青儿
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