Peripartum kardiyomiyopati: Üçüncü basamak merkez deneyimi

Yıl 2025, Cilt: 6 Sayı: 3, 326 - 333, 28.09.2025

Ezgi Başaran , Betül Akgün Aktaş , Aydan Sezgin Atakan Tanacan , Çağrı Yayla , Dilek Sahin

https://doi.org/10.47482/acmr.1740761

Öz

Arka plan: Peripartum kardiyomiyopati (PPCM), gebelikle ilişkili nadir ve idiopatik bir kardiyomiyopatidir ve kalp yetmezliği ile mortaliteye yol açabilir. Bu çalışmanın amacı, PPCM gelişen hastaların klinik özelliklerini, tanı ve tedavi yöntemlerini, prognozlarını değerlendirmek ve obstetrisyenlerin PPCM konusundaki farkındalığını artırarak erken tanı ve tedaviyi kolaylaştırmak ve böylece hasta sonuçlarını iyileştirmektir.
Yöntemler: Ekim 2019 - Ekim 2023 tarihleri arasında Bilkent Şehir Hastanesi'nde PPCM tanısı alan hastalar retrospektif olarak analiz edildi. Risk faktörleri, klinik özellikleri ve sonuçları değerlendirildi.
Bulgular: Çalışma periyodunda on iki PPCM hastası belirlendi. Sekiz hasta primigravid idi. İki hastada çoğul gebelik mevcuttu. Dört hasta antepartum, sekiz hasta ise postpartum dönemde tanı almıştı. Beş hastada preeklampsi vardı. En belirgin semptom dispne idi. Dört hastada hafif (EF ≥ %30), sekiz hastada şiddetli (EF < %30) LV disfonksiyonu saptandı. İki hasta entübe edildi; bir hasta tanıdan iki gün sonra kaybedildi. Dokuz hastada standart kalp yetmezliği tedavisine bromokriptin eklendi. Altıncı ayda 5 hastada, 12. ayda 8 hastada LVEF %50’nin üzerinde saptandı. Üç hastanın takip verilerine ulaşılamadı.
Sonuç: PPCM, nadir görülmesi ve gebelikteki normal semptomlarla ve obstetrik komplikasyonlarla örtüşmesi nedeniyle genellikle geç tanı almaktadır. Semptom başlangıcı ile tanı arasındaki süre prognozu doğrudan etkilemektedir. Bu nedenle, geç gebelik veya postpartum dönemde görülen bu patolojide erken tanı ve hızlı tedavi maternal sonuçların iyileştirilmesi açısından kritik öneme sahiptir.

Anahtar Kelimeler

Peripartum kardiyomiyopati , gebelik , kalp yetmezliği , gebelik ilişkili kardiyomiyopati , ekokardiyografi

Peripartum cardiomyopathy: Experience at a tertiary center

Öz

Background: Peripartum cardiomyopathy (PPCM) is a rare, idiopathic cardiomyopathy associated with pregnancy that can lead to heart failure and maternal mortality. This study aims to evaluate the clinical features, diagnostic and treatment approaches, and outcomes of patients diagnosed with PPCM, while also increasing awareness among obstetricians, cardiologists and emergency medicine physicians to support earlier diagnosis and intervention.
Methods: Patients diagnosed with PPCM and managed within a multidisciplinary team including the perinatology clinic between October 2019 and October 2023 were retrospectively analyzed. Risk factors, clinical presentation, and outcomes were evaluated.
Results: Twelve patients with PPCM were identified. Eight were primigravida, and two had multiple pregnancies. Four patients were diagnosed antepartum and eight postpartum. Preeclampsia was present in five cases. Dyspnea was the most common symptom. Left ventricular dysfunction was mild (EF ≥ 30%) in four patients and severe (EF <30%) in eight. Two patients required intubation, and one died on the second day following diagnosis. Bromocriptine was added to standard heart failure therapy in nine patients. At 6 months, five patients had recovered LVEF ≥ 50%, and at 12 months, eight patients achieved this level. Three patients were lost to follow-up.
Conclusion: Due to its rarity and nonspecific symptoms, PPCM is often diagnosed late, potentially worsening prognosis. Since delayed diagnosis negatively impacts outcomes, early recognition and timely initiation of treatment in late pregnancy or postpartum are vital for improving maternal health.

Anahtar Kelimeler

Peripartum cardiomyopathy , pregnancy , heart failure , pregnancy-associated cardiomyopathy , echocardiography

Kaynakça

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