Successful right heart remodelling and subsequent pregnancy in a patient with chronic thromboembolic pulmonary hypertension undergoing balloon pulmonary angioplasty: a case report

Nobutaka Ikeda; Masaru Hatano; Takeshi Nagamatsu; Masato Nakamura

doi:10.1093/ehjcr/ytz063

Successful right heart remodelling and subsequent pregnancy in a patient with chronic thromboembolic pulmonary hypertension undergoing balloon pulmonary angioplasty: a case report

Eur Heart J Case Rep. 2019 Jun 1;3(2):ytz063. doi: 10.1093/ehjcr/ytz063.

Authors

Nobutaka Ikeda¹, Masaru Hatano², Takeshi Nagamatsu³, Masato Nakamura¹

Affiliations

¹ Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo, Japan.
² Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongou, Bunkyo-ku, Tokyo, Japan.
³ Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongou, Bunkyo-ku, Tokyo, Japan.

Abstract

Background: To date, the management of pregnancy in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and the associated risk of maternal mortality have not been established. Although balloon pulmonary angioplasty (BPA) in patients with CTEPH is still an emerging procedure, this approach represents a promising alternative to pulmonary endarterectomy (PEA), especially in patients with inoperable CTEPH.

Case summary: We present a case of a 34-year-old woman with CTEPH who desired to have a child. Right heart catheterization showed a mean pulmonary artery pressure of 54 mmHg. Since the lesions were observed in the distal part of subsegmental pulmonary arteries, there was no indication for PEA. After improvement in her haemodynamic status by BPA, she became pregnant. At 40 weeks of gestation, a normal baby was delivered vaginally. Both mother and baby have made satisfactory progress.

Discussion: In cases in which the haemodynamic status is improved by effective BPA, pregnancy and childbirth may be possible, even in patients with CTEPH.

Keywords: Balloon pulmonary angioplasty (BPA); Case report; Chronic thromboembolic pulmonary hypertension (CTEPH); Pregnancy; Vaginal delivery.