128 AN UNEXPECTED ENDING OF PREGNANCY


 
 
 Dilated cardiomyopathy (DCM) is a condition whose etiologies may be various. DCM with ventricular disfunction is a frequent complication of chemotherapy. Peripartum cardiomyopathy is characterized by a reduced ejection fraction (EF), presenting toward the end of pregnancy or in the first months after delivery. Lipodystrophy may be associated to dilated and hypertrophic cardiomyopathy.
 
 
 
 A 28-years-old pregnant woman in her late 33rd week was admitted with acute heart failure complicated by pulmonary edema. The patient had history of acute lymphoblastic leukemia during childhood treated with chemo and radiotherapy, followed by hematopoietic stem cell transplantation (HSCT). Afterwards she developed partial acquired lipodystrophy, causing diabetes mellitus, insulin resistance, dyslipidemia, leptin deficiency and steatohepatitis. A mild left ventricular disfunction had been reported before HSCT, with complete recovery at follow up.
 After admission, the scenary rapidly deteriorated towards cardiogenic shock, so a caesarean section was performed. Transthoracic echocardiography revealed diffuse hypokinesia conditioning severe left ventricular (LV) dysfunction (EF 24%), moderate mitral and tricuspidal valve regurgitation and left to right shunt in possible atrial septal defect. A cycle of levosimendan was administrated, with subsequent improvement in LV function (EF 32%). Cardiac magnetic resonance (CMRI) showed hypokinetic DCM with no pathological findings in T1, T2, STIR sequences nor LGE. In parallel, empty sella in possible Sheehan Syndrome was hypothesized. A diagnosis of peripartum cardiomyopathy on the basis of a chemotherapy-induced cardiomyopathy in a good compensation status was made, with no evidence of lipodystrophy-related cardiac involvement. After recovery the patient was discharged with optimal cardiological therapy and a wearable cardioverter defibrillator. During follow up, the patient improved ventricular function (EF 40%) without any registered arrhythmia. She will be evaluated for heart transplantation.
 
 
 
 Pregnancy in patients with cardiac disease can be life-threatening for mother and fetus, a multidisciplinary approach and a correct timing are crucial to achieve the best possible result. Left ventricular disfunction can be related to many etiologies, and instrumental tests such as echocardiogram and CMRI are crucial to evaluate the cause of the disfunction. Close follow up in patients who underwent chemo/radiotherapy or are affected by metabolic diseases may avoid long-term cardiac complications.
