Biteker Murat, Duran Nilüfer Ekşi, Ozkan Mehmet
Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
Turk Kardiyol Dern Ars. 2010 Jan;38(1):32-4.
Pulmonary embolism (PE) is an important cause of morbidity and mortality during pregnancy. A 21-year-old pregnant woman presented with chest pain and progressive shortness of breath at 35 weeks of gestation. Her respiratory rate was 26 breaths/min. Electrocardiography showed sinus tachycardia and nonspecific ST-T changes. Her plasma D-dimer level was elevated (1,325 ng/ml). Transthoracic echocardiography revealed enlargement of the right ventricle and a large, highly mobile thrombus in the right atrium moving during diastole into the right ventricle. Doppler ultrasonography of the lower extremities showed bilateral acute deep femoral vein thrombosis. Following the diagnosis of right heart thrombosis with massive PE, low-dose and prolonged infusion of tissue-type plasminogen activator (25 mg in three hours) was administered. Echocardiography performed six hours after thrombolysis showed a significant decrease in the right ventricular size and complete lysis of the thrombus in the right heart. Thrombosis risk panel studies showed factor V Leiden homozygote mutation. A live newborn was delivered by cesarean section at 37 weeks of gestation. No complications were seen during a 6-month follow-up.
肺栓塞（PE）是孕期发病和死亡的重要原因。一名21岁孕妇在妊娠35周时出现胸痛和进行性气短。她的呼吸频率为26次/分钟。心电图显示窦性心动过速和非特异性ST-T改变。她的血浆D-二聚体水平升高（1325 ng/ml）。经胸超声心动图显示右心室扩大，右心房有一个大的、高度活动的血栓，在舒张期进入右心室。下肢多普勒超声显示双侧急性股深静脉血栓形成。在诊断为右心血栓形成伴大面积PE后，给予低剂量并延长组织型纤溶酶原激活剂输注（3小时内25 mg）。溶栓治疗6小时后进行的超声心动图显示右心室大小显著减小，右心血栓完全溶解。血栓形成风险评估研究显示存在因子V莱顿纯合子突变。在妊娠37周时通过剖宫产分娩出一名活产新生儿。在6个月的随访期间未发现并发症。
