Not for the Faint of Heart

Yarusi, Brett B; Jagadeesan, Vikrant; Schimmel, Daniel

doi:10.1161/circulationaha.120.046795

Cited by 2 publications

(6 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19 However, the patient in both cases had to be placed emergently on venoarterial extracorporeal membrane oxygenation (VA-ECMO) due to cardiac arrest, which we were able to avoid with our patient. 14 This discrepancy could be due to our patient presenting during the first trimester of her pregnancy and her initial hemodynamic instability leading to a rapid decision to treat with catheterdirected embolectomy. The other two patients were initially hemodynamically stable despite their PE and had spontaneous vaginal deliveries soon after their admissions.…”

Section: Discussionmentioning

confidence: 95%

“…The other two patients were initially hemodynamically stable despite their PE and had spontaneous vaginal deliveries soon after their admissions. 14 However, both patients had cardiac arrests postpartum, necessitating VA-ECMO and later catheter-directed embolectomy. 14 Both patients recovered soon after the procedure and were discharged home on therapeutic LMWH, similar to our patient.…”

Section: Discussionmentioning

confidence: 99%

“…13 Tissue plasminogen activator has also been shown to take several hours before appreciable clinical improvement, whereas a patient who underwent percutaneous catheter-directed embolectomy such as ours showed rapid improvement afterward. 14 Surgical thrombectomies during pregnancy have been associated with major bleeding episodes (7/35; 95% confidence interval [CI]: 8-37) and fetal death (2/10; 95% CI: 3-56). 12 Percutaneous mechanical thrombectomy notably has a reported maternal survival rate of 100% (7/7' 95% CI: 59-100).…”

Section: Discussionmentioning

confidence: 99%

“…There have been several reported cases of using catheterdirected embolectomy as the first-line option to treat severe PE in pregnancy prior to delivery. 6,12,[14][15][16][17][18] In two cases, the patients developed complications such as acute kidney injury, spontaneous abortion, and maternal decompensation requiring further treatment with surgical embolectomy. 16,18 In one case, the patient underwent an emergent cesarean section prior to the thrombectomy.…”

Section: Discussionmentioning

confidence: 99%

“…14 However, both patients had cardiac arrests postpartum, necessitating VA-ECMO and later catheter-directed embolectomy. 14 Both patients recovered soon after the procedure and were discharged home on therapeutic LMWH, similar to our patient. 14 The successful outcomes of these three cases indicate there is potential for catheter-directed embolectomy to be considered as a first-line treatment for hemodynamically unstable peripartum and post-partum patients with acute PE.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

See 4 more Smart Citations

Successful Treatment of Massive Pulmonary Embolism in Pregnancy with Catheter-Directed Embolectomy

Truong,

Cheyney,

et al. 2024

AJP Rep

View full text Add to dashboard Cite

Pulmonary embolism (PE) is associated with approximately 10.5% of maternal deaths in the United States. Despite heightened awareness of its mortality potential, there is little data available to guide its management in pregnancy. We present the case of a massive PE during gestation successfully treated with catheter-directed embolectomy. A 37-year-old G2P1001 presented with a syncopal episode preceded by dyspnea and chest pain. Upon presentation, she was hypotensive, tachycardiac, and hypoxic. Imaging showed an occlusive bilateral PE, right heart strain, and a possible intrauterine pregnancy. Beta-hCG was positive. She was taken emergently for catheter-directed embolectomy. Her condition immediately improved afterwards. Post-procedure pelvic ultrasound confirmed a viable intrauterine pregnancy at 10 weeks gestation. She was discharged with therapeutic enoxaparin and gave birth to a healthy infant at 38 weeks gestation. Despite being the gold standard for PE treatment in non-pregnant adults, systemic thrombolysis is relatively contraindicated in pregnancy due to concern for maternal or fetal hemorrhage. Surgical or catheter-based thrombectomies are rarely recommended. Limited alternative options forces their consideration, particularly in a hemodynamically unstable patient. Catheter-directed embolectomy can possibly bypass such complications. Our case exemplifies the consideration of catheter-directed embolectomy as the initial treatment modality of a hemodynamically unstable gestational PE.

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

See 3 more Smart Citations

Successful Treatment of Massive Pulmonary Embolism in Pregnancy with Catheter-Directed Embolectomy

Truong,

Cheyney,

et al. 2024

AJP Rep

View full text Add to dashboard Cite

show abstract

Trends and Immediate Outcomes of Syncope During Pregnancy: A Narrative Review

Javier,

Singh,

Shrestha

et al. 2023

Cureus

View full text Add to dashboard Cite

Pregnancy-related syncope presents special difficulties due to the rapid physiological changes that occur throughout gestation. This narrative review provides a thorough summary of the patterns and pregnancy outcomes secondary to syncope during pregnancy. There is an increase in syncope burden during pregnancy, and hence it is critical that medical professionals understand the significance of syncope during pregnancy. Syncope can have a negative impact on the health of the mother as well as the fetus. Therefore, this review summarizes data from studies on syncope in pregnancy. It includes observational studies, case reports, and review articles. Early detection and proper management are very important because pregnant women who experience cardiac syncope are at risk of unfavorable neonatal and maternal outcomes. The review reveals diverse trends in syncope incidence during pregnancy, emphasizing the need for a nuanced understanding of temporal variations. Risks of injury, uteroplacental insufficiency, psychological effects, interruptions in prenatal treatment, possible aggravation of pre-existing diseases, and lifestyle changes are examples of immediate maternal repercussions. Pregnancy-related syncope is a complex condition that affects the health of the mother and the fetus. The study stresses the need for careful clinical treatment due to the rapid results and the diversity in incidence patterns. The unique component of a possible relationship to the brain health of offspring justifies further investigation in this area.

show abstract

Not for the Faint of Heart

Cited by 2 publications

References 3 publications

Successful Treatment of Massive Pulmonary Embolism in Pregnancy with Catheter-Directed Embolectomy

Successful Treatment of Massive Pulmonary Embolism in Pregnancy with Catheter-Directed Embolectomy

Trends and Immediate Outcomes of Syncope During Pregnancy: A Narrative Review

Contact Info

Product

Resources

About