Abstract
We present a clinical case of successful systemic thrombolysis in a pregnant patient with massive pulmonary embolism. A 29-year old patient at 28 weeks of pregnancy was hospitalized 2 hours after sudden suffocation in a presyncopal state and hypotension of 90/50 mm Hg. ECG showed the signs of overload of right heart chambers in the form of a typical S1-Q3-T3 (McGinn–White) syndrome, as well as the Kosuge sign. Echocardiography verified pulmonary 3 Grade hypertension (81 mm Hg), enlargement of the right atrium and ventricle, 3 Grade tricuspid regurgitation and paradoxical movement of the interventricular septum. Multislice computed tomography of the chest with contrast of the pulmonary artery revealed a defect of contrast in the right main pulmonary artery, occlusive clearance, and thrombotic mass, extending to the bifurcation of the left main pulmonary artery ("clot - rider"). Thrombolytic therapy was started with recombinant tissue plasminogen activator (alteplase 10 mg bolus, then 90 mg for 2 hours). The patient was daily examined by a gynecologist. The viability of the fetus, monitoring of possible hemorrhagic complications of the placenta were evaluated. After thrombolysis, the patient began to note clinical improvement in the form of a regression of dyspnea. According to echocardioscopy control, the signs of overload of right heart chambers completely regressed. There were no complications both in the mother and in the fetus during the subsequent days until discharge. On 25.05.16 there was uncomplicated delivery vaginally of live full-term girl. Thus, when there is life-threatening massive pulmonary embolism, the application of General principles of diagnosis and treatment of this disease in patients with pregnancy is warranted. The carrying out of thrombolytic therapy in massive pulmonary embolism enables to reduce the manifestations of pulmonary hypertension, right ventricular failure, and to conduct births on time. Used intravenous thrombolytics have no teratogenic effect in the later stages of pregnancy.Received 18 April 2017. Accepted 5 June 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.
Highlights
Тромбозы глубоких вен и связанная с ними тромбоэмболия легочной артерии (ТЭЛА) являются одной из главных причин материнской смертности в мире
На фоне лечения отмечено повышение сатурации до 94%
При угрожающей жизни или потенциально инвалидизирующей массивной тромбоэмболии легочной артерии общие принципы диагностики и лечения данного заболевания у пациенток с беременностью являются оправданными и не должны откладываться
Summary
Случай успешного системного тромболизиса при массивной тромбоэмболии легочной артерии на фоне беременности. Тромбозы глубоких вен и связанная с ними тромбоэмболия легочной артерии (ТЭЛА) являются одной из главных причин материнской смертности в мире. При тромбоэмболии легочной артерии во время беременности традиционно придерживаются консервативного лечения нефракционированными или низкомолекулярными гепаринами, однако тяжелые расстройства гемодинамики, связанные с большим объ- В настоящий момент имеется крайне ограниченный опыт в проведении тромболитической терапии у беременных при ТЭЛА [9].
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