Meng Marie-Louise, Fu Annie, Westhoff Carolyn, Bacchetta Matthew, Rosenzweig Erika B, Landau Ruth, Smiley Richard
From the Departments of Anesthesiology.
Obstetrics and Gynecology.
A A Pract. 2018 Nov 15;11(10):270-272. doi: 10.1213/XAA.0000000000000806.
We report the case of a 21-year-old primiparous woman at 22 weeks gestation who presented with a large uncorrected ventricular septal defect, severe pulmonary hypertension, and Eisenmenger syndrome. The patient elected for termination of pregnancy, which was performed under regional anesthesia. Hemodynamic changes apparently associated with uterine contraction immediately after termination resulted in increased right to left shunting across the ventricular septal defect requiring urgent venovenous extracorporeal membrane oxygenation. Thrombocytopenia and systemic anticoagulation for extracorporeal membrane oxygenation presented a challenge for removal of the epidural catheter. Pulmonary hypertension was managed and she was discharged on postoperative day 35.
我们报告了一例21岁初产妇的病例，该产妇妊娠22周，患有大型未矫正室间隔缺损、严重肺动脉高压和艾森曼格综合征。患者选择终止妊娠，手术在区域麻醉下进行。终止妊娠后立即出现的明显与子宫收缩相关的血流动力学变化，导致室间隔缺损处右向左分流增加，需要紧急进行静脉-静脉体外膜肺氧合。血小板减少症以及体外膜肺氧合所需的全身抗凝给硬膜外导管的拔除带来了挑战。对肺动脉高压进行了处理，患者于术后第35天出院。
