Successful surgical management of massive pulmonary embolism during the second trimester in a parturient with heparin-induced thrombocytopenia

Abstract

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.

Non-invasive assessment of gestational hemodynamics: benefits and limitations of impedance cardiography versus other techniques

“…obstetric population [47][48][49][50][51]. Regarding the pulse contour analysis, changes in vascular tone may affect the reliability of the signal, rendering this system not useful in pregnancy where vascular tone is highly variable.…”

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

“…The prevalence of PE during pregnancy-0.3 to 3 per 1,000 pregnant women-is 5 times greater than that in nonpregnant women. 2,6,17 During pregnancy, the 3 elements of Virchow for deep vein thrombosis and…”

“…Downloaded from http://meridian.allenpress.com/doi/pdf/10.14503/THIJ-12-2692 by guest on 05 August 2020 thromboembolic sequelae can occur: hypercoagulability, venous stasis, and vascular damage. 5,6,18,19 To avoid negative consequences for the pregnant woman and fetus, an early and correct diagnosis of PE is crucial. 1,19 Diagnostic tests include chest radiography, V/Q imaging, spiral computed tomography, and pulmonary angiography.…”

“…1 Options include anticoagulation with heparin, thrombolytic therapy, transcatheter embolectomy, and surgical pulmonary embolectomy (SPE). 5,6 Earlier, SPE was considered to be the "last resort" because of the accompanying high mortality rates. 7 However, reports since 2005 suggest that a more aggressive strategy, involving a multidisciplinary approach, prompt diagnosis, and operative intervention, leads to better outcomes in patients with acute PE.…”

Minimally- and non-invasive assessment of maternal cardiac output: go with the flow!

“…There are many reports in the literature of TOE being routinely used in the diagnosis and management of high-risk cardiac conditions in pregnant women as well as its use in emergency situations such as fulminant cardiomyopathy, pulmonary and amniotic fluid emboli. [23][24][25][26][27][28] Echocardiography, however, is rarely a common skill acquired by obstetric anaesthetists or trainees and is a specialised technique unsuitable for the occasional user in an emergent delivery situation. Additionally it is necessary to not only grasp the technique of echocardiography but also to understand the normal structural and functional changes that occur during pregnancy when interpreting these studies.…”