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Brain & Heart Enhancing peripartum cardiomyopathy awareness

are younger . Preeclampsia and eclampsia are linked to consisting of cardiologists, neuroradiplogists, and cardiac
[10]
PPCM and may share common pathophysiologic pathways: surgeons. While anticoagulant therapy has shown promise
in a 2013 meta-analysis of 22 studies, preeclampsia was in the prevention of endoventricular thrombosis, surgical
found in 22% of women with PPCM, which was more than thrombectomy should be preferred over anticoagulant
4 times the estimated global prevalence . therapy in the treatment of pedunculated left ventricular
[11]
Pregnant women are often in a hypercoagulative state, thrombus, if the thrombus possess an apical morphology
which subjects them to increased levels of coagulation factors and the anticoagulant therapy gives rise to side effects.
VII, VIII, X, fibrinogen, and von Willeberand factor, together Nevertheless, more studies should be conducted to explore
with decreased protein C and S activity and fibrinolysis. the proper clinical management of patients with PPCM.
These changes usually normalize within 6 – 8 weeks after
child delivery [12,13] . Thromboembolism is the most common Acknowledgments
severe complication of PPMC, affecting 6.6% of women in None.
United States and almost 6.8% worldwide, as reported
[3]
by the EUR Observational Research Program . Aligned Funding
[13]
with the classical Virchow’ striad, mechanisms leading to None.
thrombosis in cardiac chambers are related to cardiac dilation
and global systolic function depression, which lead to blood Conflict of interest
stasis and endothelial injury . Although heart failure
[14]
medications are compatible with breastfeeding , there are The authors declare that they have no competing interest.
[15]
still no published data to guide the planning of therapeutic Author contributions
and prophylactic anticoagulant treatments after delivery.
In addition to the conventional heart failure medications, Conceptualization: Kristian Galanti, Mario Di Marino,
bromocriptine has been shown to improve heart function Roberta Magnano, Laura Pezzi
recovery . In the current case, the patient who wished Investigation: Kristian Galanti, Mario Di Marino, Roberta
[16]
to continue breastfeeding declined taking bromocriptine, Magnano, Laura Pezzi
because it could reduce prolactin production. Considering Methodology: Kristian Galanti, Alberto D’Alleva, Daniele
the increased incidence of the left ventricular thrombi and Forlani, Piergiusto Vitulli
systemic hypercoagulative state during pregnancy and Formal analysis: Kristian Galanti, Mario Di Marino,
early postpartum, Ruys et al. proposed that anti-coagulant Alberto D’Alleva, Daniele Forlani, Piergiusto Vitulli,
treatments be prescribed for prospective mothers with Vincenzo Di Egidio, Gabriele Di Giammarco,
severely decreased left ventricular EF during late pregnancy Leonardo Paloscia, Massimo Di Marco
or during 6 – 8 weeks postpartum . Warfarin should be Writing – original draft: Kristian Galanti, Mario Di Marino,
[17]
avoided during pregnancy since it can cross the placenta Roberta Magnano, Laura Pezzi
and its usage is limited to patients with mechanical heart Writing – review & editing: Alberto D’Alleva, Daniele
valves. Low-molecular-weight heparin (LMWH) can be Forlani, Piergiusto Vitulli, Vincenzo Di Egidio,
used during pregnancy since it does not cross the placenta. Gabriele Di Giammarco, Leonardo Paloscia, Sabina
Both warfarin and LMWH do not affect lactation and are Gallina, Massimo Di Marco
safe to use after child delivery. Direct oral anticoagulants
are generally avoided because their impacts on pregnancy Ethics approval and consent to participate
and lactation have never been studied . Different surgical Not applicable.
[18]
thrombectomy techniques have been described in the
literature, such as techniques coupled with transmitral or Consent for publication
apical access and robotic- and/or video-assisted surgery.
Nevertheless, the clinical management of patients with The patient has given verbal consent for the use of her
PPCM complicated by endoventricular thrombus remains a medical data.
challenge due to a lack of evidence for informing therapeutic
decision-making [19-21] . Availability of data
Not applicable.
4. Conclusion
The efficacy of the clinical treatment of pedunculated References
left endoventricular thrombus should be maximized 1. Honigberg MC, Givertz MM, 2019, Peripartum
with the combined expertise of a multidisciplinary team cardiomyopathy. BMJ, 364: k5287.

Volume 1 Issue 2 (2023) 4 https://doi.org/10.36922/bh.1115