Cardiopulmonary bypass during pregnancy is associated with a high fetal and maternal mortality. We report a successful pulmonary embolectomy in a woman at the 27th week of pregnancy; we performed surgical pulmonary embolectomy under cardiopulmonary bypass to restore adequate hemodynamic stability and to relieve right ventricle strain. We discuss the decision made for the preferred anticoagulation drug in the setting of heparin-induced thrombocytopenia in the gravida. The pregnancy was carried to term and she delivered a healthy boy at 38 weeks of gestation.

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675F. Mitropoulos et al. / Interactive CardioVascular and Thoracic Surgery 13 (2011) 672-675 fistula to the coronary sinus is the direct run-off of cardioplegic solution to the right atrium; consequently the myocardium is not protected correctly. It is advisable to administer antegrade cardioplegia with digital compression of the fistula at the level of the coronary sinus [2, 3]. Retrograde cardioplegia represents a valuable alternative in the setting of a coronary artery fistula to the coronary sinus. Our technique would have been to administer antegrade cardioplegia with external compression of the coronary sinus then, after heart arrest, to perform a 2 cm longitudinal incision on the external aspect of the coronary sinus immediately prior to its distal extremity. This opening, which is obligatory to identify the entry point of the fistula, also allows us to introduce a retrograde cardioplegia cannula.