
V. Scheggi et al. / Ntural Science 3 (2011) 37-38
Copyright © 2011 SciRes. Openly accessible at http:/ /www.scir p.org/journal/HEA LTH/
In low-risk women, fetal complications were compa-
rable to those reported for the general population but
preterm birth rate was slightly higher.
Thorne et al. [3] showed that the risk of maternal
death is approximately 7% if the patient is in New York
Heart Association (NYHA) functional class III or IV.
Other adverse risk factors include ejection fraction <
20%, mitral regurgitation, right ventricular failure, atrial
fibrillation, and systemic hypotension.
The natural history of specific types of cardiomyopa-
thy during pregnancy is unknown and there are only a
few data about pregnant women with anthracycline-in-
duced cardiomyopathy.
Anthracycline-cardiotoxicity can become manifest as
either clinical heart failure or asymptomatic cardiac
dysfunction. Both can develop also years after the cessa-
tion of treatment, as happened in our patient.
Elvira C. van Dalen [4] evaluated the incidence of pe-
ripartum anthracycline-induced clinical heart failure in a
cohort of 53 women. This study demonstrates a low risk
in childhood cancer survivors.
It is worth noticing that 2 of the 53 women included in
this study developed heart failure shortly after the end of
anthracycline therapy and that neither of them developed
any peripartum cardiac problems.
About therapy, sodium and physical activity restric-
tions, in association with drugs like digoxin and furose-
mide, help control heart failure during pregnancy.
Hydralazine, with or w ithout nitrates, is an alternative
to angiotensin-converting enzyme inhibitors, that are
associated with side effects.
As anti-arrhythmics, amiodarone may be toxic but
beta-blockers c a n be us ed safel y.
Finally, patients with ventricular dysfunction must be
anticoagulated with heparin at prophylactic doses to
prevent thromboembolism.
4. CONCLUSION
In summary, pregnancy outcome in women who re-
ceived anthracyclines for malignancy in childhood is
generally favorable. Th ose with left ventricular dysfunc-
tion, as our patient, should be considered at increased
risk but probably the most important prognostic f actor is
the NYHA class.
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