Poor Hooman, Serrao Gregory, Grapsa Julia, Chandrashekhar Y S, Bianco Angela, Lookstein Robert A, Fuster Valentin
Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
JACC Case Rep. 2022 Oct 17;6:101650. doi: 10.1016/j.jaccas.2022.10.001. eCollection 2023 Jan 18.
While in labor, a 37-year-old woman developed acute dyspnea, hypoxemia, and tachycardia. Transthoracic echocardiography demonstrated severe right ventricular dilation and dysfunction, raising the suspicion of acute pulmonary embolism. The patient indeed had bilateral pulmonary embolism, necessitating percutaneous thrombectomy. Her course was complicated by another saddle pulmonary embolus, heparin-induced thrombocytopenia, and COVID-19 infection. This clinical case illustrates the importance of prompt diagnosis of acute pulmonary embolism in a peripartum female patient, the multidisciplinary approach of management, and how to approach clinical complications such as heparin-induced thrombocytopenia. Furthermore, long-term management in acute pulmonary embolism is presented.
一名37岁女性在分娩时出现急性呼吸困难、低氧血症和心动过速。经胸超声心动图显示严重的右心室扩张和功能障碍，怀疑为急性肺栓塞。该患者确实患有双侧肺栓塞，需要进行经皮血栓切除术。她的病程因另一个鞍状肺栓塞、肝素诱导的血小板减少症和新冠病毒感染而复杂化。本临床病例说明了对围产期女性患者急性肺栓塞进行及时诊断的重要性、多学科管理方法以及如何处理肝素诱导的血小板减少症等临床并发症。此外，还介绍了急性肺栓塞的长期管理。
