[Post-partum myocardiopathy. Apropos of 25 cases]

The authors have studied 25 cases of PPC which were selected according to very strict criteria. These cases represent 1 case of PPC for every 2 687 confinements, and 37.8% of all cardiomyopathies in females of child-bearing age. The females with PPC belonged to the more deprived socio-economic population. Multiparity and twin pregnancies are predisposing factors. The clinical picture is usually one of biventricular of left heart failure. Four cases of embolism are included (16%, which is a high figure for Africa). The special investigations are important. Mechanographic studies show a very significant lengthening of the pre-ejection phase (especially QB1), and a reduced ejection phase; haemodynamic studies show in particular increased pressures on the right side in 4 cases out of 6. (3 of which had an arterio-capillary gradient). Angiocardiography, carried out in 4 cases, showed abnormalities especially of the left ventricle (especially dilation and hypokenesia). The outcome may be favourable, especially after 3 to 6 months have elapsed. However, complications may arise in the long-term (10, 14 and 37 months). There were two deaths (8%). Histologically, the lesions were mainly of a congestive type, with some areas of fibrosis, and rarely areas of inflammation (myocarditis). From the aetiological standpoint, it might be thought that during the posptpartum period, various abnormal conditions prevail or would be discovered (13 in our series); but it is also true that some cases of true PPC, with marked stasis and a tendency to thrombosis, as well as severe involvement of the myocardium (as witnessed especially by the mechanographic findings), to progress after 3 months either to resolution, death, or complications; the histological findings in the two fatal cases were of myocarditis.