Successful surgical management of massive pulmonary embolism during the second trimester in a parturient with heparin-induced thrombocytopenia.
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.
Hajj-Chahine
Jamil
J
Department of Cardio-thoracic Surgery, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, 2 Rue de la Milétrie, 86021 Poitiers cedex, France. jamilhajjchahine@yahoo.fr
Jayle
Christophe
C
Tomasi
Jacques
J
Corbi
Pierre
P
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D017548:Echocardiography, Transesophageal; D017128:Embolectomy; D017984:Enoxaparin / Q000008:administration & dosage; D005260:Female; D000077425:Fondaparinux; D006324:Heart Arrest, Induced; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth; D008297:Male; D011134:Polysaccharides / Q000008:administration & dosage; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011262:Pregnancy Trimester, Second; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013921:Thrombocytopenia / Q000139:chemically induced*; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy*; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D017984:Enoxaparin; D011134:Polysaccharides; D014443:Tyrosine; D014859:Warfarin; D006493:Heparin; D000077466:Tirofiban; D000077425:Fondaparinux