Peripartum cardiomyopathy. Clinical case series.

We report a retrospective analysis of four cases of peripartum cardiomyopat hy admitted, within a IO-year period, to the maternity hospital of Sousse. The age of the patients was over 30 years, two had gemellary pregnancies an d two suffered toxaemia, Congestive cardiac failure, mainly of the left ven tricle, with acute pulmonary oedema, was the main symptom. Chest X-ray show ed a cardiothoracic index above 0.58 and echocardiography a left ventricula r telediastolic diameter above 5.7 cm and a shortening ratio of 25% or less . Endomyocardial biopsy for ascertaining the diagnosis was not available. T reatment included bed rest, water and salt restriction, digitalis, a diuret ic and an anticoagulant in case antepartum cardiomyopathy, a converting enz yme inhibitor and a diuretic in case of postpartum cardiomyopathy. Three pa tients recovered totally and in one echocardiography showed a persisting im paired left ventricular function. Five neonates had a favourable outcome an d one foetus died in utero. Main problems raised by peripartum cardiomyopat hy are discussed. (C) 1999 Elsevier, Paris.