O'Riordan Devaki, Kiely David G, O'Driscoll B Ronan
1 Manchester Academic Health Sciences Centre, Department of Respiratory Medicine, Salford Royal Foundation NHS Trust, Salford, Manchester, UK.
2 105629 Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK.
Pulm Circ. 2018 Jul-Sep;8(3):2045894018775190. doi: 10.1177/2045894018775190. Epub 2018 Apr 19.
Deterioration, or a new presentation, of pulmonary arterial hypertension (PAH), are recognized complications of pregnancy. In this report, we describe a patient with a family history of PAH who developed peripartum breathlessness and hypoxemia with ventilation-perfusion mismatch but no evidence of thromboembolism or PAH. Significantly reduced perfusion at both lung bases was noted on perfusion scintigraphy and three-dimensional magnetic resonance (3D-MR) perfusion maps in the immediate postpartum period. These abnormalities spontaneously resolved by 16 weeks postpartum, consistent with reversible pulmonary abnormalities of pulmonary perfusion. However, she developed new breathlessness four years later and was found to have developed PAH. This case provides a mechanism which may contribute to the high mortality seen in pregnant patients with PAH in the peripartum period.
肺动脉高压（PAH）病情恶化或出现新症状是公认的妊娠并发症。在本报告中，我们描述了一名有PAH家族史的患者，她在围产期出现呼吸困难和低氧血症，伴有通气-灌注不匹配，但无血栓栓塞或PAH证据。产后即刻的灌注闪烁扫描和三维磁共振（3D-MR）灌注图显示双肺基底灌注显著减少。这些异常在产后16周时自发缓解，符合肺灌注可逆性异常。然而，四年后她出现了新的呼吸困难，被发现已发展为PAH。该病例提供了一种机制，可能导致PAH妊娠患者在围产期出现高死亡率。
