Successful pulmonary embolectomy for massive pulmonary embolism during pregnancy: a case report

Abstract

BackgroundPulmonary embolism (PE) resulting from venous thromboembolism is a leading cause of maternal mortality in pregnancy. In patients with massive PE and hemodynamic instability, the treatment options often considered are thrombolytics, inferior vena caval filters, or embolectomy. We report here the case of a patient with massive PE at 28 weeks’ gestation, who underwent emergency pulmonary embolectomy via cardiopulmonary bypass.Case presentationA 35-year old primigravida with a history of massive PE at 25 weeks of gestation was referred to our hospital at 28 weeks of gestation, following treatment failure after insertion of an inferior vena cava filter and heparin administration. Emergency thrombectomy was performed, and intracardiac echography was used for intraoperative fetal heart rate monitoring. However, the patient developed hemodynamic collapse following anesthesia induction; hence, emergency cardiopulmonary bypass (CPB) was performed via median sternotomy. Thrombectomy and tricuspid valve plication were performed under cardiac arrest. After confirming postoperative hemostasis, heparin administration was resumed. At 40 weeks of gestation, labor was induced under epidural analgesia. Both mother and child were discharged with no complications.ConclusionIn conclusion, intracardiac echography is useful for fetal heart rate monitoring during emergency cardiac surgery in pregnancy. Careful CPB management is important to maintain uteroplacental blood flow. Although there is no consensus on the delivery methods in such cases, epidural analgesia during labor was useful in reducing cardiac load and wound traction.

Management of Acute Saddle Pulmonary Embolism in Pregnancy Following Fetal Surgery

“…Pulmonary embolism is the third most common cardiovascular disease behind coronary artery disease and stroke with an annual incidence of approximately 70 per 100,000, and current data suggest that rates may be much higher due to the presence of a "silent PE" formation in up to 50% of patients with DVT [3][4]. Of note, autopsy reports show that a mere 30-35% of PE are diagnosed before death [5].…”

Pulmonary Thromboendarterectomy for Chronic Pulmonary Thromboembolism

“…Pulmonary thromboembolism a squeal of VTE having multiple causes is one of the pronounced cause of mortality in hospital and outside as well. But due to its varied presentation and nonspecific nature of symptoms like dyspnea, cough, pleuritic pain, sub sternal chest pain, fever, syncope and hemoptysis, it remains undiagnosed 1 .…”

“…To define pulmonary embolism we can say it is the obstruction of pulmonary vasculature by thrombus which has embolized from other site in the blood stream causing variety of symptoms depending upon dimensions and location of thrombus 1,8 .…”

Pulmonary Embolism in Pregnancy: A Review for Clinical Practitioners

“…Surgical thrombectomy is more frequently considered for the treatment of PE during pregnancy, especially in cases where anticoagulation is ineffective, or the patient is hemodynamically unstable [104]. Surgical thrombectomy with cardiopulmonary bypass is performed without cardioplegia by removing proximal pulmonary clots through incisions in the two main pulmonary arteries.…”