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Varying Peripartum Courses in Two Parturients with Cardiac Sarcoidosis
Abstract Number: F-65
Abstract Type: Case Report/Case Series
Sarcoidosis is an uncommon multisystem granulomatous disease with a predilection for reproductive-aged women. Cardiac sarcoidosis is a rare manifestation of the disease and has an estimated incidence in pregnancy of 0.05% (1). Cardiac sarcoidosis has life-threatening manifestations including left ventricular dysfunction, congestive heart failure, and atrioventricular block (2) and so these patients require close monitoring.
There is little literature about parturients with cardiac sarcoidosis. We present two cases of young women with cardiac sarcoidosis and their peripartum courses. One patient had isolated cardiac sarcoidosis. Her LVEF improved over the course of her pregnancy, from 36% in her first trimester to 49% at full term. She underwent a planned induction of labor at 38 weeks gestation due to her cardiomyopathy. She had an unremarkable spontaneous vaginal delivery with an epidural in labor. Her postpartum course was also uneventful and she was discharged home on postpartum day two. The second patient had chronic pulmonary and cardiac sarcoidosis. Her TTEs throughout pregnancy demonstrated a moderately reduced LVEF and global dysfunction. She required admission at 34 weeks gestation due to preterm premature rupture of membranes and was initially observed. She ultimately required an urgent repeat cesarean section due to concern for placental abruption and developing heart failure. A TTE on admission showed an LVEF of 36% and a mildly enlarged right heart with reduced function, which was a new echo finding. Her section was performed under general anesthesia with arterial and central lines and her induction was performed with high dose opioid medications to minimize hemodynamic changes. She remained intubated postoperatively due to suspected acute right heart failure. She was extubated on postoperative day two and was discharged home on postoperative day four.
Our two patients demonstrate that the peripartum courses of patients with cardiac sarcoidosis can vary widely. Case series suggest that some parturients with cardiac sarcoidosis do well in pregnancy and their disease may even improve, as was seen with our first patient’s improved LVEF. This improvement may be partly attributed to pregnancy being an immunosuppressed state (1). Existing literature also suggests that patients with more severe sarcoidosis at pregnancy onset, as seen with our second patient, have a higher potential for peripartum decompensation. Clinicians cannot entirely predict which patients with cardiac sarcoidosis will do well and which will not. As a result, all parturients should be considered high risk, should have repeat echos if new symptoms arise and should be followed closely by a multidisciplinary team including Obstetrics, Anesthesiology, Cardiology and Intensive Care.
1.De Regt RH. Sarcoidosis in Pregnancy.Obstetrics and Gynecology 70(3): 369-372, 1987.
2.Kim JS, Judson MA, Donnino R et al.Cardiac Sarcoidosis. American Heart Journal 157(1): 9-21, 2009