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General Thoracic and Cardiovascular Surgery

, Volume 65, Issue 9, pp 532–534 | Cite as

Cesarean section in the setting of severe pulmonary hypertension requiring extracorporeal life support

  • Ryosuke Hara
  • Shuhei Hara
  • Chin Siang Ong
  • Gary Schwartz
  • Christopher Sciortino
  • Narutoshi HibinoEmail author
Case Report

Abstract

We describe the use of veno-arterial extracorporeal membrane oxygenation (ECMO) in a 35-year-old female with severe fixed pulmonary hypertension who went into cardiogenic shock during a Cesarean section. Pregnancy in the presence of severe pulmonary hypertension is typically contraindicated due to high maternal mortality rates. This patient visited our hospital at 37 weeks of gestation after experiencing dyspnea and chest pain. Clinical evaluation revealed severe fixed pulmonary hypertension. At the time of the planned delivery, femoral lines were placed; in case of emergency, ECMO became necessary during the delivery. During delivery, the patient developed sudden hemodynamic collapse necessitating rapid cannulation and initiation of ECMO. She was stabilized pharmacologically and separated from ECMO after 2 days. The baby was delivered uneventfully, and the mother and child were discharged 1 month after delivery.

Keywords

Cesarean section Pulmonary hypertension ECMO 

Notes

Acknowledgements

We wish to express our sincere gratitude to Prof. Duke E. Cameron, Prof. Ko Bando, and Prof. Kazuhiro Hashimoto for their guidance and encouragement to prepare this manuscript.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest.

References

  1. 1.
    Madden BP. Pulmonary hypertension and pregnancy. Int J Obstet Anesth. 2009;18:156–64.CrossRefPubMedGoogle Scholar
  2. 2.
    Kim HY, Jeon HJ, Yun JH, Lee JH, Lee GG, Woo SC. Anesthetic experience using extracorporeal membrane oxygenation for cesarean section in the patient with peripartum cardiomyopathy: a case report. Koren J Anesthesiol. 2014;66:392–7.CrossRefGoogle Scholar
  3. 3.
    Sharma NS, Wille KM, Bellot SC, Diaz-Guzman E. Modern use of extracorporeal life support in pregnancy and postpartum. ASAIO J. 2015;61:110–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Satoh H, Masuda Y, Izuta S, Yaku H, Obara H. Pregnant patient with primary pulmonary hypertension: general anesthesia and extracorporeal membrane oxygenation support for termination of pregnancy. Anesthesiology. 2002;97:1638–40.CrossRefPubMedGoogle Scholar
  5. 5.
    Moore SA, Dietl CA, Coleman DM. Extracorporeal life support during pregnancy. J Thorac Cardiovasc Surg. 2016;151(4):1154–60.CrossRefPubMedGoogle Scholar
  6. 6.
    Katsuragi S, Yamanaka K, Neki R, Kamiya C, Sasaki Y, Osato K, et al. Maternal outcome in pregnancy complicated with pulmonary arterial hypertension. Circ J. 2012;76:2249–54.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2016

Authors and Affiliations

  • Ryosuke Hara
    • 1
  • Shuhei Hara
    • 1
  • Chin Siang Ong
    • 1
  • Gary Schwartz
    • 1
  • Christopher Sciortino
    • 1
  • Narutoshi Hibino
    • 1
    Email author
  1. 1.Division of Cardiac SurgeryThe Johns Hopkins HospitalBaltimoreUSA

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