[Postpartum myocardiopathy. Clinical and echographic evaluations of the response to treatment. 30 cases observed in the Sudan-sahelian area].

Thirty cases of postpartum cardiomyopathy observed in a savannah-sahelian region of Africa (Niamey, Republic of Niger) are reported. The dilated cardiomyopathy was diagnosed by comparing clinical signs with electrocardiographic, radioscopic and echocardiographic findings. A simplified therapeutic regimen was used in all cases: rest during 2 months, sodium restriction, diuretic and digoxin therapy (1 tablet of each drug every other day). Patients were followed up for a mean period of 13 months. The course of the disease was evaluated at regular intervals by echocardiography which provided accurate information on left ventricular function. At the time of diagnosis all patients had congestive heart failure. Complete remission was defined as the absence of all signs and a normal social life. Twelve patients answered this definition with a mean follow-up of 13 months. Nine patients (mean follow-up 24 months) were in incomplete remission; a large left ventricular aneurysm had developed in 2 of them. In 6 other patients the follow-up was too short (1 to 8 months) for a prognosis to be formulated. In postpartum cardiomyopathy 3 factors are indicative of a poor prognosis: 1) absence of free interval between delivery and first signs of heart failure; 2) history of cardiomyopathy after previous deliveries; 3) poor response to treatment with persistent cardiomegaly. On the other hand, the severity of the initial cardiomegaly and impairment of ventricular contractility, and the presence of permanent hypertension or pericardial effusion have no significant influence on the response to treatment. Irreversible contraception is justified in great multiparous women. In primiparous and oligoparous women a temporary contraception is necessary, a new pregnancy being conceivable only after complete remission and under close supervision.