Acute postpartale hypoxemie: een diagnose van reumatisch mitraliskleplijden

Abstract

Acute postpartum hypoxemia: diagnosis of rheumatic mitral valve disease Among various causes for peri- and postpartum respiratory insufficiency, rheumatic mitral valve disease is a less common, yet potentially dangerous condition. In Europe, the incidence of rheumatic fever is low, making rheumatic heart valve disease rare. However, as a result of modern migration of patients from endemic regions, one must be aware of possible associated underlying valvular disease in young patients. A 42-year-old patient of North African ethnicity undergoing an elective C-section develops acute hypoxemia during the procedure, persisting postpartum despite the administration of oxygen. Initially, more obvious causes, such as a high spinal block and an allergic reaction, are excluded. A CT scan formally excludes a pulmonary embolism, but is suggestive of heart failure. A consecutive transthoracic echocardiography confirms acute decompensated heart failure with pathognomonic characteristics of rheumatic mitral valve disease. The patient is admitted to the cardiac intensive care unit, where the administration of oxygen and an intravenous treatment with diuretics have a favorable result. A low-dose beta blocker is initiated prior to discharge 5 days postpartum. Although rheumatic mitral stenosis is less common in Europe, one should consider this disease entity in the differential diagnosis when confronted with sudden (cardio)respiratory insufficiency in the parturient. Through this case, the authors highlight the implications of rheumatic mitral valve stenosis during pregnancy and the possible triggers for peripartum cardiac decompensation.