Experience in diagnostics and surgical treatment of pulmonary embolism in pregnant women

Abstract

Pulmonary embolism (PE) is a serious and frequent extragenital complication of pregnancy, yet too few descriptions of its treatment exist. This article describes three clinical cases of surgical treatment of pregnant women with the diagnosis of massive critical PE resulted from deep vein thrombosis of the lower extremities and small pelvis with recurrent embolic syndrome. The diagnoses were confirmed with instrumental methods (echoCG, multislice spiral CT angiography). The patients were operated by employing the technique of open thromboembolectomy from the pulmonary arteries on the beating heart. It was found that results and terms of different therapies are determined by the area of lesion and localization of emboli in pulmonary vascular bed. The optimal surgery technique in this case is embolectomy from pulmonary arteries in conditions of artificial circulation on the beating heart without aortic compression with minimized perfusion time and maintaining high volume velocity (2.4 L/min/m2) and average arterial blood pressure (70–75 mm Hg) that allows fast and complete recovery of pulmonary hemodynamics. Refusal from the use of cardioplegia contributes to adequate delivery of oxygen to tissues and the fetus; in two cases it was possible to prolong pregnancy with further childbirth, in one case an emergency caesarean section was performed. The authors note the importance of a thorough examination, a selection of an adequate preoperative therapy and the need for emergency surgery in patients in a severe state. The results of the study show that open embolectomy from pulmonary arteries in case of massive critical PE in pregnant women can save mother’s life and ensure the birth of a healthy child.