Abstract 15019: Safe Implantation of Remote Pulmonary Artery Pressure Monitoring System (CARDIOMEMS) in a Pregnant Patient With Severe Heart Failure

Abstract

Introduction: Heart failure (HF) in pregnancy is associated with high maternal and neonatal mortality. Remote pulmonary artery pressure (PAP)-guided management of HF has been shown to reduce hospitalizations and mortality in HF patients. However, PAP monitoring systems (CardioMEMS) have not been implanted during pregnancy. We describe the first case of safe implantation of CarioMEMS in a pregnant patient with HF. Case report: A 38-year-old female with past medical history of non-ischemic cardiomyopathy with an ejection fraction of 15%, left ventricular thrombus, pulmonary hypertension, and atrial fibrillation was found to be 14 weeks pregnant by the obstetrician, and her HF medications were appropriately discontinued. The patient was continued on metoprolol, amlodipine, and enoxaparin and was advised to terminate the pregnancy due to high risk of maternal mortality, however, she decided against it. An interdisciplinary team of obstetricians and cardiologists managed the patient during her pregnancy. As the pregnancy progressed, the patient had multiple hospitalizations due to decompensated HF. To optimize her hemodynamic status and guide diuretic therapy, a decision to implant CardioMEMS was made after a risk-benefit discussion, at 23 weeks of gestation. A long wire and sheath were used from a femoral venous access to limit fluoroscopy. A right heart catheterization was performed, and cardiac filling pressures and output were measured. Minimal contrast (7.5 ml of iodixanol) was used to perform selective pulmonary artery angiography and the sensor was implanted according to manufacturer recommendations. Total fluoroscopic exposure during the procedure was 11.2 minutes (183 Gy-cm2). Patient’s diuresis and afterload reduction was adjusted based on PAP. Conclusion: Remote PAP monitoring system can be safely implanted in pregnant patients using limited contrast and fluoroscopic exposure to proactively manage heart failure.