Évolution et complications thromboemboliques de la myocardiopathie idiopathique du péripartum au CHU de Dakar : étude prospective à propos de 33 cas

Abstract

The aims of this work are to study the nursery futures during idiopathic myocardiopathy of peripartum (IMPP), to measure the prevalence of thromboses and spontaneous contrast during the IMPP and to determine their evolution. It is about a longitudinal exploratory study carried out with the Aristide-Le-Dantec teaching hospital of Dakar, beginning January 2001 to November 2004, having included 33 patients. The average age of the patients was 26 years; the average pregnancy was of 3.39 gestures. The signs of cardiac insufficiency were constant and four patients (12%) had presented an ischemic cerebral vascular accident. We had raised an auricular case of fibrillation and tachycardia atrial multifocal. The transthoracic echography (ETT) noted an aspect of hypokinetic myocardiopathy dilated with deterioration of the systolic function of the left ventricle, a thrombus in ten patients (30.3%) and a spontaneous contrast in two cases (6%). The transoesophageal echocardiography (ETO) was superposable with the ETT with regard to dimensions of the cardiac cavities and the presence of thrombus but its sensitivity was higher (100% against 66%) with regard to the detection of contrasts spontaneous. All the patients had the treatment of a congestive heart failure associated to an anticoagulant treatment. The evolution was marked by an improvement of the heart failure. The thrombus and spontaneous contrast had disappeared in all the patients. The absence of anaemia and the presence of spontaneous contrast (p=0.003) were correlated with the presence of thrombosis (p=0.05). The idiopathic myocardiopathy of the peripartum is a relatively frequent affection in zone Soudano-Sahelian. Occurrence of thromboses is frequent at the time of this affection. Our study confirms the superiority of the echocardiography transoesophageal in the detection of intracardiac spontaneous contrast. The evolution can be favourable subject to a rigorous care and a regular surveillance.