Case ReportChallenge of Pregnancy in Patients With Pre-Capillary Pulmonary Hypertension: Veno-Arterial Extracorporeal Membrane Oxygenation as an Innovative Support for Delivery
Section snippets
Case 1
A 31-year-old Caucasian woman affected with thalassemia intermedia requiring regular red blood cell transfusion was referred to the ISMETT PH center because of a suspicion of PH in the 20th week of pregnancy. She presented with lower extremity edema, dyspnea on effort, right ventricle D-shaped enlargement with preserved contractility, an estimated systolic PAP of 70 mmHg, and a World Health Organization Functional Class III (WHO FC III). She recovered rapidly after IV infusion of furosemide,
Discussion
In cases of PH, pregnancy, with its inherent increased circulating volume and hypercoagulability, results in an unacceptable maternal mortality rate of between 30% and 50%.12 The authors describe 2 cases of successful pregnancy in women affected with severe pre-capillary PH with a multi-specialist approach,13, 14 including pulmonologists, cardiologists, anesthesiologists, obstetricians, and neonatologist experts in PH management.
Cesarean section is the preferred way to perform delivery in the
References (14)
- et al.
Pregnancy and primary pulmonary hypertension: Successful outcome with epoprostenol therapy
Chest
(2001) Pulmonary hypertension and pregnancy
International J Obstetric Anesth
(2009)- et al.
Intravenous epoprostenol in inoperable chronic thromboembolic pulmonary hypertension
J Heart Lung Transplantation
(2007) - et al.
2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT)
Eur Heart J
(2016) - et al.
Birth control and pregnancy management in pulmonary hypertension
Seminars in respiratory and critical care medicine
(2013) - et al.
Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension?
Eur Heart J
(2009) - et al.
Veno-arterial ECMO in severe acute right ventricular failure with pulmonary obstructive hemodynamic pattern
J Invasive Cardiol
(2010)
Cited by (12)
Extracorporeal Membrane Oxygenation During Adult Noncardiac Surgery and Perioperative Emergencies: A Narrative Review
2021, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :This leads to acute right heart failure and hypoxemia refractory to oxygen supplementation and pulmonary vasodilators. The use of ECMO, both preemptively and emergently, for midtrimester termination of pregnancy or cesarean delivery has been reported in several case reports.76–80 Although the use of VV ECMO has been described in the management of patients with Eisenmenger syndrome,77 VA ECMO may be more appropriate in the presence of right ventricular dysfunction by unloading the right heart chambers, bypassing the high-resistance pulmonary circulation, and providing systemic perfusion.
Extracorporeal Membrane Oxygenation: Beyond Cardiac Surgery and Intensive Care Unit: Unconventional Uses and Future Perspectives
2018, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Two introducers were placed preoperatively in the femoral vessel to allow for rapid ECMO deployment in case of intraoperative acute decompensation, although the patient ultimately did not require ECMO support.116 Similar cases with “standby” ECMO use have been described by other authors, with good outcome both for the mother and fetus.116,117,119 In the obstetrics setting, ECMO has been adopted in patients who experienced dysfunction of a mitral valve prosthesis,118 pulmonary hypertension,119,121 pulmonary embolism,120 and methamphetamine-induced cardiomyopathy.117
Pregnancy in Patients with Pulmonary Arterial Hypertension in Light of New ESC Guidelines on Pulmonary Hypertension
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