Nahapetian Arby, Oudiz Ronald J
Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, Calif., USA.
Cardiology. 2008;109(4):237-40. doi: 10.1159/000107786. Epub 2007 Sep 17.
We report a case of a woman who became pregnant after the diagnosis of moderate to severe pulmonary hypertension and underwent successful full-term pregnancy. Pulmonary hemodynamics were monitored before pregnancy and in the peripartum period. The patient was followed closely by the cardiology and high-risk obstetric specialists in the outpatient setting until she underwent c-section with epidural anesthesia. Outpatient medical management included twice daily subcutaneous enoxaparin and once daily amlodipine. Immediately prior to cesarian section, and for several days postoperatively, invasive hemodynamic monitoring was employed to titrate medical therapy. During delivery, strict attention focused on limiting intravenous fluids in order to avoid right ventricular volume overload. The postoperative course was complicated by a spontaneous, acute rise in pulmonary vascular resistance, which was managed with intravenous epoprostenol. In addition, abdominal bleeding, likely related to postoperative anticoagulation and platelet dysfunction, was controlled with transfusion and spontaneously resolved after discontinuing the anticoagulation. This case presents a favorable outcome in a pregnant patient undergoing cesarian section despite several complications related to pulmonary hypertension and right ventricular dysfunction, which are often fatal.
我们报告了一例在诊断为中度至重度肺动脉高压后怀孕的女性病例，该患者成功足月妊娠。在怀孕前和围产期对肺血流动力学进行了监测。在门诊环境中，心脏病学和高危产科专家对该患者进行了密切随访，直至她接受硬膜外麻醉下的剖宫产手术。门诊医疗管理包括每日两次皮下注射依诺肝素和每日一次氨氯地平。在剖宫产手术前即刻以及术后数天，采用有创血流动力学监测来调整药物治疗。分娩期间，严格注意限制静脉输液量，以避免右心室容量超负荷。术后病程因肺血管阻力自发急性升高而复杂化，通过静脉注射依前列醇进行处理。此外，可能与术后抗凝和血小板功能障碍相关的腹腔出血，通过输血得到控制，并在停用抗凝药物后自发缓解。尽管存在与肺动脉高压和右心室功能障碍相关的多种并发症（这些并发症通常是致命的），但该病例中接受剖宫产手术的孕妇仍获得了良好的结局。
