Cesarean section in the setting of severe pulmonary hypertension requiring extracorporeal life support

Hara, Ryosuke; Hara, Shigeta; Ong, Chin Siang; Schwartz, Gary S.; Sciortino, Christopher M.; Hibino, Narutoshi

doi:10.1007/s11748-016-0729-x

Cited by 9 publications

(3 citation statements)

References 6 publications

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“…In one case report, a patient with severe PAH at 37 weeks of gestation planned for a cesarean section with epidural analgesia had preemptive femoral vein and arterial access with 16-gauge catheters that were emergently upsized for VA-ECMO cannulation, was successfully delivered and discharged after 1 month. 65 Data on the use of ECMO in pregnancy remains limited, however.…”

Section: Medical Management During Deliverymentioning

confidence: 99%

Pulmonary Hypertension in Pregnancy

Banerjee

Ventetuolo

2017

Semin Respir Crit Care Med

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Pulmonary arterial hypertension (PAH) is a pulmonary vasculopathy associated with abnormal cardiopulmonary hemodynamics and a limited life expectancy due to right heart failure. Young women are preferentially affected. Women with PAH are at increased risk of complications and death during pregnancy for both the mother and the fetus. While it is not well characterized how changes in sex steroids and other hormones during pregnancy affect pulmonary hypertension, many expected systemic and heart–lung physiologic adaptations during gestation are poorly tolerated in women with PAH. Despite the approval of numerous therapies for PAH in recent years, pregnancy avoidance or early termination is still recommended in women with PAH because of poor outcomes. In this review, we will discuss physiologic and hormonal changes in pregnancy as they relate to pulmonary vascular disease and right heart function. We will review current consensus recommendations and outline the management of pregnancy in PAH when it does occur.

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Section: Medical Management During Deliverymentioning

confidence: 99%

Pulmonary Hypertension in Pregnancy

Banerjee

Ventetuolo

2017

Semin Respir Crit Care Med

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“…Additional vasodilator pharmacological options (endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, guanylate cyclase stimulators) are generally limited because of possible fetal toxicity [6]. Use of mechanical cardiovascular support has been described in the peripartum period and despite increased bleeding risks and questionable long-term outcomes, it can be lifesaving during sudden cardiovascular collapse and therefore should be considered as an emergency intervention during delivery [7, 10, 11].…”

Section: Discussionmentioning

confidence: 99%

Management of acutely decompensated chronic thromboembolic pulmonary hypertension in late pregnancy: a case report

Valkó

Csósza

Mérei

et al. 2019

BMC Pregnancy Childbirth

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BackgroundPregnancy in patients with pulmonary hypertension is associated with increased risk of maternal and fetal death. Physiological changes during pregnancy, labor and the postpartum period may all lead to acute decompensation of chronic right heart failure with rapid progression to circulatory collapse. As such, guidelines discourage planned pregnancies in women suffering from pulmonary hypertension. There are, however, rare cases of pulmonary hypertension which have previously been undiagnosed and only become apparent during late stage pregnancy. These individuals require close monitoring and multidisciplinary management.Case presentationWe describe the case of a 34-year-old female who presented with acute decompensation of previously undiagnosed pulmonary hypertension during the 30th week of her second pregnancy. Echocardiography and CT scan confirmed severe pulmonary hypertension and right heart failure with no new thromboembolic component. Following stabilization of cardiorespiratory parameters with high FiO2 noninvasive ventilation, intravenous epoprostenol and levosimendan treatment, Cesarean section was performed under epidural anesthesia. Close monitoring was continued in the postoperative period and cardiovascular parameters were managed with ongoing inotropic and escalating vasodilator therapy. The findings were consistent with chronic thromboembolic pulmonary hypertension. Persistent hypoxia was found to be a result of right bronchial obstruction caused by blood clots, which resolved with bronchoscopic intervention. Ongoing postpartum management resulted in improved cardiovascular parameters and oxygenation. Epoprostenol treatment was successfully converted to subcutaneous treprostinil therapy and the patient was discharged home to care for her healthy baby girl. Optimal timing of pulmonary endarterectomy will be chosen based upon functional status and patient preference.ConclusionsThe case described is the first published report of previously undiagnosed pulmonary hypertension presenting with acute right heart failure in late pregnancy successfully managed by pharmacological therapy, noninvasive ventilation and a Cesarean performed under epidural anesthesia. The case illustrates that despite the challenges, acutely discovered right heart failure can be successfully managed with a comprehensive multidisciplinary treatment plan.

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“…13 ECMO is also used in a BTD model for patients with PAH who decompensate during pregnancy. [14][15][16][17] In our case, ECMO was used as a BTR model. BTR is the use of ECMO in patients with decompensated right heart failure while medications are titrated or causes of decompensation are reversed.…”

Section: Discussionmentioning

confidence: 99%

PH Grand Rounds: A Successful Case of Extracorporeal Membrane Oxygenation As a Bridge to Recovery

Levine¹,

Jernigan

Mankad

et al. 2018

Advances in Pulmonary Hypertension

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Presentation:A 50-year-old male with no known medical history presented to clinic for one year of progressive dyspnea on exertion. His family later confirmed patient was actively using methamphetamines. He was found to be in respiratory distress and was admitted to a community hospital, where he was intubated for acute hypoxic respiratory failure. Following intubation, he became hemodynamically unstable, required 3 vasopressor infusions, and had ongoing hypoxia with an oxygenation saturation of 88% on maximum ventilator support. Labs were notable for serum drug screen positivity for amphetamines and alcohol. Transthoracic echocardiogram (TTE) was performed and showed dilatation of the right ventricle (RV ), an intra-atrial shunt, and elevated estimated pulmonary arterial (PA) systolic pressures. Our tertiary care center was contacted for extracorporeal membrane oxygenation (ECMO) and transfer for management of pulmonary hypertension (PH) with right heart failure and refractory hypoxia.

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Cesarean section in the setting of severe pulmonary hypertension requiring extracorporeal life support

Cited by 9 publications

References 6 publications

Pulmonary Hypertension in Pregnancy

Pulmonary Hypertension in Pregnancy

Management of acutely decompensated chronic thromboembolic pulmonary hypertension in late pregnancy: a case report

PH Grand Rounds: A Successful Case of Extracorporeal Membrane Oxygenation As a Bridge to Recovery

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