{
    "abstract": "Pulmonary embolism (PE) resulting from venous thromboembolism is a leading cause of maternal mortality in pregnancy. In patients with massive PE and hemodynamic instability, the treatment options often considered are thrombolytics, inferior vena caval filters, or embolectomy. We report here the case of a patient with massive PE at 28\u00a0weeks' gestation, who underwent emergency pulmonary embolectomy via cardiopulmonary bypass.\nA 35-year old primigravida with a history of massive PE at 25\u00a0weeks of gestation was referred to our hospital at 28\u00a0weeks of gestation, following treatment failure after insertion of an inferior vena cava filter and heparin administration. Emergency thrombectomy was performed, and intracardiac echography was used for intraoperative fetal heart rate monitoring. However, the patient developed hemodynamic collapse following anesthesia induction; hence, emergency cardiopulmonary bypass (CPB) was performed via median sternotomy. Thrombectomy and tricuspid valve plication were performed under cardiac arrest. After confirming postoperative hemostasis, heparin administration was resumed. At 40\u00a0weeks of gestation, labor was induced under epidural analgesia. Both mother and child were discharged with no complications.\nIn conclusion, intracardiac echography is useful for fetal heart rate monitoring during emergency cardiac surgery in pregnancy. Careful CPB management is important to maintain uteroplacental blood flow. Although there is no consensus on the delivery methods in such cases, epidural analgesia during labor was useful in reducing cardiac load and wound traction.",
    "authors": [
        {
            "affiliation": "Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 5650871 Japan.",
            "firstname": "Hiroki",
            "initials": "H",
            "lastname": "Taenaka"
        },
        {
            "affiliation": "Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 5650871 Japan.",
            "firstname": "Chiyo",
            "initials": "C",
            "lastname": "Ootaki"
        },
        {
            "affiliation": "Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 5650871 Japan.",
            "firstname": "Chie",
            "initials": "C",
            "lastname": "Matsuda"
        },
        {
            "affiliation": "Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 5650871 Japan.",
            "firstname": "Yuji",
            "initials": "Y",
            "lastname": "Fujino"
        }
    ],
    "conclusions": "In conclusion, intracardiac echography is useful for fetal heart rate monitoring during emergency cardiac surgery in pregnancy. Careful CPB management is important to maintain uteroplacental blood flow. Although there is no consensus on the delivery methods in such cases, epidural analgesia during labor was useful in reducing cardiac load and wound traction.",
    "copyrights": null,
    "doi": "10.1186/s40981-017-0116-3\n10.1016/S0140-6736(09)60996-X\n10.1097/01.CCM.0000183157.15533.4C\n10.1001/archinte.162.11.1221\n10.1016/j.athoracsur.2010.11.037\n10.1016/j.athoracsur.2013.10.067\n10.1016/S0003-4975(00)01178-4\n10.1213/ane.0b013e31819367aa\n10.1161/01.CIR.101.7.828\n10.1056/NEJMct0909254\n10.1054/ijoa.2001.0873",
    "journal": "JA clinical reports",
    "keywords": [
        "Embolectomy",
        "Fetal monitoring",
        "Intracardiac echography",
        "Labor epidural",
        "Massive pulmonary embolism",
        "Preterm cardiac surgery"
    ],
    "methods": null,
    "publication_date": "2018-02-20",
    "pubmed_id": "29457088\n19889451\n16215350\n12038939\n21440145\n24630768\n10546719\n10881866\n9677799\n19224782\n10683360\n20410515\n15321583",
    "results": null,
    "title": "Successful pulmonary embolectomy for massive pulmonary embolism during pregnancy: a case report.",
    "xml": "<Element 'PubmedArticle' at 0x7885040f1120>"
}