[Maternal mortality due to cardiovascular disease in France 2013-2015]

Between 2013 and 2015, cardiovascular diseases became one of the two leading causes of maternal mortality, with 36 deaths (13.7% of maternal deaths). The overall maternal mortality ratio for cardiovascular diseases is 1.5 per 100,000 live births, stable compared to the 2010-2012 period. The etiologies in order of decreasing frequency are: pre-existing cardiomyopathies (n=10), aortic dissections (n=9), peripartum cardiomyopathies (n=6), myocardial infarction (n=4), valvular cardiopathies (n=4). Non-optimal care occurred in 72% of cases, increasing since the previous triennium (50%). Similarly, there is a significant increase in the proportion of preventable deaths (possibly or probably) from 35% to 66%. In women with known cardiovascular disease, the lack of multidisciplinary prepregnancy assessment and pregnancy follow-up is most frequent. In patients with unknown cardiovascular disease, the lack of diagnosis of a cardiac event is the most common failure. Cardiovascular conditions or cardiovascular risk factors should be investigated in early pregnancy in order to monitor and refer women to appropriate maternity hospitals. Recent dyspnea, worsening at the end of pregnancy and postpartum, should suggest a cardiac complication. In presence of chest pain, aortic dissection should be considered with the same degree of emergency as myocardial infarction or pulmonary embolism. Cardiac ultrasonography, chest CT, Nt-proBNP and troponin should be considered in case of chest pain or recent dyspnea. Women with cardiac symptoms should be referred to an emergency department (not necessarily to the local maternity) for a complete cardiovascular check-up.

AIDS-related primary cardiac lymphoma with right-sided heart failure and high-grade AV block: insights from magnetic resonance imaging

A 44-year-old patient, with personal history of AIDS, was referred to our emergency unit with tachycardia and moderate signs of right-sided heart failure. The cardiac MRI study showed an impairment of the right ventricular free and inferior wall and the interventricular septum. The mass was characterized by notable heterogeneity with mixed areas of hypo- and hypersignal intensity in SSFP and T2-weighted images with fat saturation. There was global hyperenhancement of the mass after gadolinium contrast injection on T1-weighted images with and without fat saturation. The entire right coronary artery was included into the infiltrative mass. One day after the admission, the patient suddenly presented a paroxysmal third degree atrioventricular block, permanently corrected by an implanted cardiac pacemaker. Endomyocardial biopsy conformed the diagnosis of B-cell lymphoma. The patient died 4months after the diagnosis of acute heart failure with multi-organ dysfunction, after a short period of improvement under chemotherapy. We present this case to highlight the importance to consider that a large, solitary, right atrial mass in conjunction with pericardial effusion in a patient with HIV infection should lead to consider, as soon as possible, the diagnosis of lymphoma. MRI has explained the conduction disorders by showing the septal extension of the mass, and by demonstrating right coronary artery involvement.