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Review
. 2024 Aug 12;13(16):4732.
doi: 10.3390/jcm13164732.

Myocardial Involvement in Catastrophic Antiphospholipid Syndrome during Pregnancy or Puerperium: A Case of a Young Breastfeeding Woman and Literature Review

Leonardo Varotto  1 , Luca Spigolon  2 , Alberto Dotto  3 , Denis Leonardi  3 , Giulia Bragantini  1 , Luca Felice Cerrito  1 , Cristina Deluca  4 , Ariela Hoxha  5
Affiliations
Review

Myocardial Involvement in Catastrophic Antiphospholipid Syndrome during Pregnancy or Puerperium: A Case of a Young Breastfeeding Woman and Literature Review

Leonardo Varotto et al. J Clin Med. .

Abstract

Catastrophic Antiphospholipid Syndrome (CAPS) is a rare complication that can occur in patients with Antiphospholipid Syndrome (APS). CAPS occurs even more rarely during pregnancy/puerperium and pregnant patients, even less likely to show cardiac involvement without signs of damage on ultrasound and angiography with non-obstructive coronary arteries. We present a case of a 26-year-old breastfeeding woman, the youngest described with CAPS and acute myocardial infarction, whose diagnosis was made with cardiac magnetic resonance imaging (CMRI). A literature review of pregnant patients with similar problems was performed. There are diagnostic and therapeutic difficulties in treating these patients. CMRI demonstrated a transmural late enhancement area. A combination of therapies led to rapid clinical improvement. CMRI is an underused tool that reaffirms the pathophysiology of CAPS and leads clinicians to the possibility of a diffuse thrombotic process. CAPS involves more organs with high mortality rates. CMRI could be optimized in order to reach an early diagnosis and the most effective treatment. This study provides real-world evidence of the feasibility of MRI in a primary care setting during pregnancy/puerperium. Evidence from this study may influence future APS screening and inform policymakers regarding the use of leading MRI technology in the detection of the thrombotic process in a primary care setting.

Keywords: antiphospholipid syndrome; cardiac magnetic resonance imaging; catastrophic antiphospholipid syndrome; heart involvement; myocardial infarction with non-obstructive coronary arteries; pregnancy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) Angiography CT scan showing the presence of some filling defects (yellow curved arrow) in a segmental branch of the right lower lobe of the lung. (B) Lung CT scan with axial scanning showing the presence of multiple ground-glass opacities in the lower lobes (small yellow arrowhead). (C) Multiplanar reconstruction of angiography CT scan highlighting some filling defects (yellow curved arrow) in a segmental branch of the right lower lobe of the lung. (D) Volume-rendering reconstruction highlighting the location of a filling defect in a branch of the right lower pulmonary artery (yellow straight arrow). (E) Contrast-enhanced CT image revealing a hypodense formation anterior to the inferior vena cava. (F) MRI image demonstrating disappearance and healing of the hepatic lesion.
Figure 2
Figure 2
CMRI PSIR T1 sequences. Evidence of LGE suggestive of focused transmural myocardial fibrosis affecting the middle lateral left ventricle wall, through cardiac two-chamber short axis (on the left) and four-chamber long axis (on the right).
See this image and copyright information in PMC

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