1
|
Wang J, Lu J. Anesthesia for Pregnant Women with Pulmonary Hypertension. J Cardiothorac Vasc Anesth 2020; 35:2201-2211. [PMID: 32736999 DOI: 10.1053/j.jvca.2020.06.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
Abstract
Despite advances in the therapy for pulmonary hypertension over the past decades, the prognosis of pregnant patients with pulmonary hypertension remains poor, with high maternal mortality. This poses a particular challenge for the mother and her medical team. In the present review, the authors have updated the classification and definition of pulmonary hypertension, summarized the current knowledge with regard to perioperative management and anesthesia considerations for these patients, and stressed the importance of a "pregnancy heart team" to improve long-term outcomes of pregnant women with pulmonary hypertension.
Collapse
Affiliation(s)
- Jiawan Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiakai Lu
- Department of Anesthesiology, Beijing An-Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
| |
Collapse
|
2
|
Valko L, Csosza G, Merei A, Muhl D, Faludi R, Karlocai K, Lorx A, Gal J. Management of acutely decompensated chronic thromboembolic pulmonary hypertension in late pregnancy: a case report. BMC Pregnancy Childbirth 2019; 19:365. [PMID: 31638921 PMCID: PMC6805312 DOI: 10.1186/s12884-019-2545-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/09/2019] [Indexed: 11/17/2022] Open
Abstract
Background Pregnancy in patients with pulmonary hypertension is associated with increased risk of maternal and fetal death. Physiological changes during pregnancy, labor and the postpartum period may all lead to acute decompensation of chronic right heart failure with rapid progression to circulatory collapse. As such, guidelines discourage planned pregnancies in women suffering from pulmonary hypertension. There are, however, rare cases of pulmonary hypertension which have previously been undiagnosed and only become apparent during late stage pregnancy. These individuals require close monitoring and multidisciplinary management. Case presentation We describe the case of a 34-year-old female who presented with acute decompensation of previously undiagnosed pulmonary hypertension during the 30th week of her second pregnancy. Echocardiography and CT scan confirmed severe pulmonary hypertension and right heart failure with no new thromboembolic component. Following stabilization of cardiorespiratory parameters with high FiO2 noninvasive ventilation, intravenous epoprostenol and levosimendan treatment, Cesarean section was performed under epidural anesthesia. Close monitoring was continued in the postoperative period and cardiovascular parameters were managed with ongoing inotropic and escalating vasodilator therapy. The findings were consistent with chronic thromboembolic pulmonary hypertension. Persistent hypoxia was found to be a result of right bronchial obstruction caused by blood clots, which resolved with bronchoscopic intervention. Ongoing postpartum management resulted in improved cardiovascular parameters and oxygenation. Epoprostenol treatment was successfully converted to subcutaneous treprostinil therapy and the patient was discharged home to care for her healthy baby girl. Optimal timing of pulmonary endarterectomy will be chosen based upon functional status and patient preference. Conclusions The case described is the first published report of previously undiagnosed pulmonary hypertension presenting with acute right heart failure in late pregnancy successfully managed by pharmacological therapy, noninvasive ventilation and a Cesarean performed under epidural anesthesia. The case illustrates that despite the challenges, acutely discovered right heart failure can be successfully managed with a comprehensive multidisciplinary treatment plan.
Collapse
Affiliation(s)
- Luca Valko
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Ulloi ut 78/B, Budapest, 1082, Hungary.
| | - Gyorgyi Csosza
- Department of Pulmonology, Semmelweis University, Dios arok u. 1, Budapest, 1125, Hungary
| | - Akos Merei
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pecs, Ifjusag u. 13, Pecs, 7624, Hungary
| | - Diana Muhl
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pecs, Ifjusag u. 13, Pecs, 7624, Hungary
| | - Reka Faludi
- Heart Institute, Medical School, University of Pecs, Ifjusag u. 13, Pecs, 7624, Hungary
| | - Kristof Karlocai
- Department of Pulmonology, Semmelweis University, Dios arok u. 1, Budapest, 1125, Hungary
| | - Andras Lorx
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Ulloi ut 78/B, Budapest, 1082, Hungary
| | - Janos Gal
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Ulloi ut 78/B, Budapest, 1082, Hungary
| |
Collapse
|
3
|
De novo left ventricular non-compaction accompanied by severe mitral valve failure in a young pregnant. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:292-295. [PMID: 32082749 DOI: 10.5606/tgkdc.dergisi.2018.15676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/25/2018] [Indexed: 11/21/2022]
Abstract
De novo left ventricular non-compaction is a rare pathology in the peripartum period. To the best of our knowledge, pregnancy-induced cardiomyopathy accompanied by severe mitral valve insufficiency requiring surgery during pregnancy has not been previously reported. Herein, we report the first postpartum case of de novo left ventricular non-compaction who underwent mitral valve repair.
Collapse
|