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Review
. 2014 Apr 1;41(2):188-94.
doi: 10.14503/THIJ-12-2692. eCollection 2014 Apr.

Emergent surgical pulmonary embolectomy in a pregnant woman: case report and literature review

Giovanni Saeed  1 , Michael Möller  1 , Jörg Neuzner  1 , Rainer Gradaus  1 , Werner Stein  1 , Uwe Langebrake  1 , Thomas Dimpfl  1 , Meradjoddin Matin  1 , Ali Peivandi  1
Affiliations
Review

Emergent surgical pulmonary embolectomy in a pregnant woman: case report and literature review

Giovanni Saeed et al. Tex Heart Inst J. .

Abstract

Acute pulmonary embolism is a leading cause of death during pregnancy and delivery in the United States. We describe the case of a 25-year-old woman who presented in cardiogenic shock in week 38 of her first pregnancy. After the emergent cesarean delivery of a healthy male neonate, the mother underwent immediate surgical pulmonary embolectomy. We confirmed the diagnosis of pulmonary embolism intraoperatively by means of transesophageal echocardiography and removed large clots from the patient's pulmonary arteries. Mother and child were doing well, 27 months later. In addition to presenting our patient's case, we discuss the other relevant reports and the options for treating massive pulmonary embolism during pregnancy.

Keywords: Cesarean section; embolectomy/methods; pregnancy complications, cardiovascular/diagnosis/surgery; pregnancy outcome; pregnancy trimester, third; pulmonary embolism/complications/surgery; risk assessment; thrombosis/surgery; treatment outcome; ventricular dysfunction, right/etiology.

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Figures

Fig. 1
Fig. 1
Preoperative transthoracic echocardiogram (modified 3-chamber view) shows a markedly dilated, hypocontractile right ventricle and billowing of the interventricular septum into the left ventricle. IVS = interventricular septum; LA = left atrium, LV = left ventricle; RA = right atrium; RV = right ventricle
Fig. 2
Fig. 2
Preoperative transthoracic echocardiogram (left parasternal long-axis view) shows deviation of the interventricular septum toward the left ventricle and its small cavity. AML = anterior mitral leaflet; Ao = aorta; IVS = interventricular septum; LV = left ventricle; PML = posterior mitral leaflet; RV = right ventricle
Fig. 3
Fig. 3
Intraoperative transesophageal echocardiogram immediately after cesarean delivery shows subtotal thrombotic occlusion of the mother's main pulmonary artery. MPA = main pulmonary artery; TMC = thrombotic clots
Fig. 4
Fig. 4
Photograph shows thrombotic clots removed from the main and branch pulmonary arteries.
See this image and copyright information in PMC

References

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