High-Risk Pulmonary Embolism During Labor: JACC Patient Care Pathways

Hooman Poor; Gregory Serrao; Julia Grapsa; Y S Chandrashekhar; Angela Bianco; Robert A Lookstein; Valentin Fuster

doi:10.1016/j.jaccas.2022.10.001

High-Risk Pulmonary Embolism During Labor: JACC Patient Care Pathways

JACC Case Rep. 2022 Oct 17:6:101650. doi: 10.1016/j.jaccas.2022.10.001. eCollection 2023 Jan 18.

Authors

Hooman Poor¹, Gregory Serrao², Julia Grapsa³, Y S Chandrashekhar⁴, Angela Bianco⁵, Robert A Lookstein⁶, Valentin Fuster²

Affiliations

¹ Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
² The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³ Department of Cardiovascular Sciences, Guys and St Thomas NHS Trust, Long, United Kingdom.
⁴ University of Minnesota, Minneapolis, Minnesota, USA.
⁵ Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁶ Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Abstract

While in labor, a 37-year-old woman developed acute dyspnea, hypoxemia, and tachycardia. Transthoracic echocardiography demonstrated severe right ventricular dilation and dysfunction, raising the suspicion of acute pulmonary embolism. The patient indeed had bilateral pulmonary embolism, necessitating percutaneous thrombectomy. Her course was complicated by another saddle pulmonary embolus, heparin-induced thrombocytopenia, and COVID-19 infection. This clinical case illustrates the importance of prompt diagnosis of acute pulmonary embolism in a peripartum female patient, the multidisciplinary approach of management, and how to approach clinical complications such as heparin-induced thrombocytopenia. Furthermore, long-term management in acute pulmonary embolism is presented.

Keywords: CT, computed tomography; CTA, computed tomography angiogram; CTPA, computed tomography pulmonary angiography; ECMO, extracorporeal membrane oxygenation; HIT, heparin-induced thrombocytopenia; LV, left ventricle; PE, pulmonary embolism; PVR, pulmonary vascular resistance; RV, right ventricle; SBP, systolic blood pressure; TTE, transthoracic echocardiogram; multimodality imaging; pregnancy; pulmonary embolism.

Publication types

Review