Emergency Embolectomy in a Patient with Massive Pulmonary Embolism during Second Trimester Pregnancy

Abstract

Emergency pulmonary embolectomy was performed successfully on a patient in her second trimester of pregnancy. The patient had severe right ventricular failure due to obstruction of 85% of the pulmonary arterial circulation. Three months after embolectomy she was delivered of a normal infant. The problem of significant but misinterpreted or overlooked clinical and electrocardiographic signs of pulmonary embolism is discussed. Thrombolytic therapy during pregnancy imposes considerable risk of bleeding with deleterious effects on both mother and fetus. In our opinion, emergency embolectomy during extracorporeal circulation is the best treatment in case of massive emboli during pregnancy.

Emergency Pulmonary Embolectomy During the Second Trimester of Pregnancy: Report of a Case

“…There are several reports on cardiac surgery being performed during the second trimester of pregnancy. 4,7,8 At this gestational age, induced abortion is possible to save the mother's life. The risk factors for fetal mortality in cardiac surgery during pregnancy are a maternal age higher than 35 years and emergency surgery.…”

“…The fi ndings of several case reports and case series suggest that there is a lower risk of fetal loss associated with thrombolytic therapy than with embolectomy. 4 Because right ventricular dysfunction caused by acute pulmonary embolism is associated with a poor prognosis, pharmacological or mechanical removal of emboli must be considered to improve the patient's chances of survival. Although thrombolytic therapy is thought to affect the fetus minimally, it is contraindicated for patients with a bleeding tendency or severe thrombocytopenia.…”

Emergent Surgical Pulmonary Embolectomy in a Pregnant Woman: Case Report and Literature Review

“…Our review of the English-language medical literature from 1970 through 2012 yielded 12 other case reports that described SPE for massive PE during pregnancy. 6,18,[24][25][26][27][28][29][30][31][32][33] Table I summarizes the clinical characteristics, presenting symptoms and signs, diagnostic methods, clinical courses, indications for SPE, and fetal and maternal outcomes. In all 13 patients, (age range, 21-39 yr), the clinical manifestation of PE was not dominated by one symptom or sign, but rather by combinations. The most frequent presentations were respiratory and cardiac: dyspnea in 9 patients, tachycardia in 5, cyanosis in 4, tachypnea in 4, hypoxemia in 2, acute respiratory distress in 1, and palpitations in 1.…”

Clinical and hemodynamic spectrum, diagnosis, and treatment of acute pulmonary embolism: The aggressive approach

“…After completion of the primary treatment, all patients were started on antithrombotic treatment with warfarin-sodium for at least six months except 1 patient who underwent embolectomy during second trimester pregnancy (Blegvad et al 1989) and who received low-dose heparin treatment until vaginal delivery at term of a normal infant.…”

“…These studies were, however, highly selective: they excluded patients with minor emboli, those with massive emboli and cardiocirculatory shock, those with symptom duration of more than five to seven days, and those with preexisting cardiopulmonary disease. Analysis of an unselected group of patients with acute symptomatic pulmonary embolism referred to centralized treatment during the period 1975-1983 led us to adopt a different attitude toward diagnostic strategy (Lund et al 1986b;Nielsen et al 1989) and choice of treatment (Lund et al 1987;Blegvad et al 1989;Lund et al 1986a). As a main change, we broadened the indications for pulmonary embolectomy during extracorporeal circulation (ECC) to embrace all patients with central emboli, including those with stable circulation (Lund et al 1987(Lund et al , 1986a.…”