Chronic thromboembolic pulmonary hypertension, pregnancy, and a pulmonary endarterectomy: a rare challenge.
It is well described that patients with group 1 forms of pulmonary arterial hypertension have a high risk of mortality during pregnancy and in the early postpartum period. However, to the authors' knowledge, the diagnosis and management of group 4 pulmonary hypertension due to chronic thromboembolic pulmonary hypertension (CTEPH) during pregnancy with early postpartum pulmonary endarterectomy (PEA) has not been previously reported. We report the case of a 28-year-old woman who received a diagnosis of CTEPH during her pregnancy, was managed as an inpatient by a multidisciplinary team throughout the pregnancy and early postpartum period, and underwent PEA 6 weeks after delivery. While the management of acute pulmonary embolus in pregnancy is well described, this unique case of CTEPH diagnosed during pregnancy illustrates several challenging management issues.
Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA.
Erika B
EB
Rosenzweig
Department of Thoracic Surgery, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA.
Mauer
M
Biscotti
Department of Obstetrics and Gynecology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA.
Kirsten
K
Cleary
Department of Anesthesiology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA.
Richard
R
Smiley
Department of Thoracic Surgery, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA.
Matthew D
MD
Bacchetta
ECMO; chronic thromboembolic pulmonary hypertension (CTEPH); pregnancy; pulmonary endarterectomy (PEA); pulmonary hypertension
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