[A case of delayed diagnosis of pulmonary thromboembolism in a patient with mitral stenosis undergoing cesarean section].
Cesarean section was performed under general anesthesia in a 38-year-old patient with congestive heart failure due to severe mitral stenosis. During surgery, pulmonary hypertension, right ventricular distension and the dissociation of PETCO2 and PaCO2 were observed. However, pulmonary thromboembolism (PTE) was proved after the operation when she developed severe hypotension in the intensive care unit. Although she recovered once from circulatory unstability with the use of percutaneous cardiopulmonary support (PCPS) and she could be weaned from PCPS at the 4th postoperative day, she died from tracheal bleeding and recurrent cardiopulmonary collapse 22nd day after the surgery. It should be noted that the increasing dissociation of PETCO2 and PaCO2 may be an early sign of PTE even in a patient with severe mitral stenosis and pulmonary hypertension.
Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara 228-8555.
Hiroshi
H
Kimotsuki
Masayuki
M
Kuroiwa
Masayasu
M
Arai
Tomoaki
T
Takenaka
Hirotsugu
H
Okamoto
Sumio
S
Hoka
D000328:Adult; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section; D003951:Diagnostic Errors; D017809:Fatal Outcome; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008946:Mitral Valve Stenosis / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000209:etiology*