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首页> 外文期刊>Journal of Clinical Medicine Research >Reversion of Severe Mitral Insufficiency in Peripartum Cardiomyopathy Using Levosimendan
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Reversion of Severe Mitral Insufficiency in Peripartum Cardiomyopathy Using Levosimendan

机译：使用左西孟旦逆转围产期心肌病中的严重二尖瓣关闭不全

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Idiopathic peripartum cardiomyopathy presenting with heart failure is a true diagnostic and treatment challenge. Goal oriented clinical management aims at the relapse of left ventricular systolic dysfunction. A 35-year-old patient on her 12th day post-delivery presents progressive signs of heart failure. Transthoracic echocardiography showed severe mitral insufficiency, mild left ventricular dysfunction, mild tricuspid insufficiency, severe pulmonary hypertension, and right atrial enlargement. With wet and cold heart failure signs, the patient was a candidate for inodilator cardiovascular support and volume depletion therapy. As the patient presented a persistent tachycardia at rest, levosimendan was chosen over dobutamine. Levosimendan was administered at a dose of 0.2 μg/kg/min during a period of 24 hours. After inodilator therapy, the patient’s signs and symptoms of heart failure began to decrease, showing improvement of dyspnea, mitral murmur grade went from IV/IV to II/IV, filling pressures and systemic and pulmonary resistance indexes decreased, arterial blood gases improved, and an echocardiography performed 72 h later showed non-dilated cardiomyopathy, mild cardiac contractile dysfunction, mild mitral insufficiency, type I diastolic dysfunction and improvement of pulmonary hypertension. Cardiovascular function in peripartum cardiomyopathy tends to go back to normality in 23-41% of the cases, but in a large group of patients, severe ventricle dysfunction remains months after initial symptoms. This article describes the diagnostic process of a patient with peripartum cardiomyopathy and a successful reversion of a severe case of mitral insufficiency using levosimendan as a new therapeutic strategy in this clinical context.J Clin Med Res. 2015;7(12):998-1001doi: http://dx.doi.org/10.14740/jocmr2323
机译：伴有心力衰竭的特发性围产期心肌病是真正的诊断和治疗挑战。面向目标的临床管理旨在复发左心室收缩功能障碍。一名35岁的患者在分娩后的第12天出现心力衰竭的进行性体征。经胸超声心动图检查显示严重的二尖瓣关闭不全，轻度的左心室功能不全，轻度的三尖瓣功能不全，严重的肺动脉高压和右心房扩大。患有湿性和冷性心力衰竭迹象，该患者是扩大心血管支持和容量消耗疗法的候选人。由于患者在休息时表现为持续性心动过速，因此左西孟旦优于多巴酚丁胺。在24小时内，左西孟旦的剂量为0.2μg/ kg / min。扩张剂治疗后，患者心力衰竭的体征和症状开始减轻，表现为呼吸困难，二尖瓣杂音等级从IV / IV降至II / IV，充盈压和全身及肺阻力指数降低，动脉血气改善，并且72小时后进行的超声心动图检查显示非扩张型心肌病，轻度心脏收缩功能障碍，轻度二尖瓣关闭不全，I型舒张功能障碍和肺动脉高压的改善。围产期心肌病的心血管功能在23-41％的病例中趋于恢复正常，但是在大量患者中，严重的心室功能障碍在最初症状出现数月后仍然存在。本文描述了围产期心肌病患者的诊断过程，并在此临床背景下使用左西孟旦作为新的治疗策略成功治愈了严重的二尖瓣关闭不全的病例.J Clin Med Res。 2015; 7（12）：998-1001doi：http://dx.doi.org/10.14740/jocmr2323

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