Successful treatment of postpartum shock caused by amniotic fluid embolism with cardiopulmonary bypass and pulmonary artery thromboembolectomy

Ra, Esposito; Grossi, Enzo; Coppa, Gene F.; Giangola, Gary; Ferri, DP; Angelides, EM; Andriakos, Peter

doi:10.1016/0020-7292(91)90862-y

Cited by 6 publications

(6 citation statements)

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“…ECMO and intra-aortic balloon counterpulsation might be considered in left ventricular failure unresponsive to medical therapy [136]. The successful treatment of a moribund patient with cardiopulmonary bypass and PA thromboembolectomy has also been shown [137].…”

Section: Clinical Signsmentioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

European Respiratory Journal

161

127

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Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes.The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than ''simple'' mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung.NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE.Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.

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Section: Clinical Signsmentioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

European Respiratory Journal

161

127

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“…33,51,53 However, more recently, there have been two case reports in which amniotic fluid embolus was accompanied by massive thrombotic pulmonary embolus. 35,54 This suggests that, in a minority of patients, critical obstruction of the main branches of the pulmonary arteries can occur.…”

Section: Hemodynamic Changesmentioning

confidence: 99%

Amniotic fluid embolus: a review of the literature

Davies

2001

Can J Anesth/J Can Anesth

111

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88Purpose: To review the literature since 1979 to determine the natural history, etiology, diagnosis and potential treatment of amniotic fluid embolus (AFE).Source: English language articles and books published between June 1976 and June 1998 were identified by a computerized medline search using the title or text word amniotic fluid embolus. This same search strategy was repeated and updated to October 1999 by an independent individual using both Medline and Embase. The search was also expanded to include Science Citation Index listing Morgan's 1979 review article. All relevant publications were retrieved and their bibliographies were scanned for additional sources.Principal findings: Randomized controlled trials are not possible with amniotic fluid emboli. The majority of the literature consists of clinical reports combined with occasional limited reviews. Knowledge obtained from these reports suggests that amniotic fluid emboli present as a spectrum of disease that ranges from a subclinical entity to one that is rapidly fatal. Because cases are sporadic and the diagnosis is often unconfirmed, little progress has been made towards understanding its etiology or defining the risk factors. Present management is empirical and directed towards the maintenance of oxygenation, circulatory support and the correction of coagulopathy.Conclusion: Amniotic fluid embolus continues to be a life-threatening but potentially reversible complication unique to pregnancy. It cannot be predicted nor prevented. Review of the literature reveals that there are no standardized investigational methods or protocols to confirm the diagnosis in suspected cases.Objectif : Passer en revue la littérature depuis 1979 pour déterminer l'histoire naturelle, l'étiologie, le diagnostic et le traitement potentiel d'une embolie amniotique (EA).Source : Des articles et des livres de langue anglaise, publiés entre juin 1976 et juin 1998, ont été sélectionnés lors d'une recherche informatisée de données médicales en utilisant les titres ou l'expression amniotic fluid embolus. La même méthode de recherche a été utilisée par un individu indépendant pour obtenir une mise à jour jusqu'en octobre 1999 avec Medline et Embase. La recherche a été étendue au Science Citation Index qui présentait la revue de Morgan de 1979. Tous les articles pertinents ont été retenus et leurs bibliographies examinées pour découvrir des sources supplémentaires.Constatations principales : Les essais contrôlés et randomisés sur l'embolie amniotique sont impossibles. La plus grande partie de la documentation constituée de résumés cliniques combinés à des revues limitées occasionnelles. Les connaissances dégagées de ces résumés suggèrent que l'embolie amniotique se présente comme de multiples affections allant de l'entité subclinique à la maladie rapidement fatale. Les cas étant rares et le diagnostic souvent non confirmé, peu de progrès ont été réalisés pour mieux en comprendre les causes ou pour définir ses facteurs de risque. Le traitement actuel est empirique et vise à maintenir...

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“…Furthermore, our literature search revealed a few cases of AFE successfully managed with cardiopulmonary bypass and pulmonary artery thromboembolectomy. 16,17 Thus, this case illustrates the feasibility of cardiopulmonary bypass surgery and thromboembolectomy in the management of AFE complicated by intracardiac or pulmonary embolism.…”

Section: Commentmentioning

confidence: 84%

Amniotic Fluid Embolism Complicated by Paradoxical Embolism and Disseminated Intravascular Coagulation

Kumar

Wong

Maysky

et al. 2010

American Journal of Critical Care

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Amniotic fluid embolism is a rare syndrome with potentially lethal outcomes. Complications include cardiorespiratory failure, disseminated intravascular coagulation, seizures, neurological deficits, and death. A 34-year-old woman had amniotic fluid embolism complicated by paradoxical embolism and disseminated intravascular coagulation. Emergency cesarean section followed by cardiopulmonary bypass with removal of the clot from the atria and closure of the patent foramen ovale was performed, resulting in a good outcome for both the mother and the baby. Subsequent treatment with anticoagulants for 6 months was recommended. A literature review revealed that this clinical scenario is rare but can be successfully managed by cardiopulmonary bypass and thromboembolectomy. Data on guidelines for the use of anticoagulation in this situation are limited.

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Successful treatment of postpartum shock caused by amniotic fluid embolism with cardiopulmonary bypass and pulmonary artery thromboembolectomy

Cited by 6 publications

References 0 publications

Nonthrombotic pulmonary embolism

Nonthrombotic pulmonary embolism

Amniotic fluid embolus: a review of the literature

Amniotic Fluid Embolism Complicated by Paradoxical Embolism and Disseminated Intravascular Coagulation

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