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CC BY-NC-ND 4.0 · AJP Rep 2024; 14(02): e140-e144
DOI: 10.1055/a-2299-4026
Case Report

Successful Treatment of Massive Pulmonary Embolism in Pregnancy with Catheter-Directed Embolectomy

Rachel D. Truong 
1   Department of Internal Medicine, Orlando Regional Medical Center, Orlando, Florida
,
Sarah Cheyney
2   Department of Pulmonary and Critical Care Medicine, Orlando Regional Medical Center, Orlando, Florida
,
Mai Vo
2   Department of Pulmonary and Critical Care Medicine, Orlando Regional Medical Center, Orlando, Florida
,
Joel Garcia
3   Department of Interventional Cardiology, Orlando Regional Medical Center, Orlando, Florida
,
Neeraj N. Desai
4   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Winnie Palmer Hospital, Orlando, Florida
,
Jacqueline Kropf
5   Department of Hematology and Medical Oncology, Orlando Health Cancer Institute, Orlando, Florida
,
Hatem Hassanein
5   Department of Hematology and Medical Oncology, Orlando Health Cancer Institute, Orlando, Florida
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Abstract

Introduction Pulmonary embolism (PE) is associated with approximately 10.5% of maternal deaths in the United States. Despite heightened awareness of its mortality potential, there islittle data available to guide its management in pregnancy. We present the case of a massive PE during gestation successfully treated with catheter-directed embolectomy.

Case Presentation A 37-year-old G2P1001 presented with a syncopal episode preceded by dyspnea and chest pain. Upon presentation, she was hypotensive, tachycardiac, and hypoxic. Imaging showed an occlusive bilateral PE, right heart strain, and a possible intrauterine pregnancy. Beta-human chorionic gonadotropin was positive. She was taken emergently for catheter-directed embolectomy. Her condition immediately improved afterward. Postprocedure pelvic ultrasound confirmed a viable intrauterine pregnancy at 10 weeks gestation. She was discharged with therapeutic enoxaparin and gave birth to a healthy infant at 38 weeks gestation.

Conclusion Despite being the gold standard for PE treatment in nonpregnant adults, systemic thrombolysis is relatively contraindicated in pregnancy due to concern for maternal or fetal hemorrhage. Surgical or catheter-based thrombectomies are rarely recommended. Limited alternative options force their consideration, particularly in a hemodynamically unstable patient. Catheter-directed embolectomy can possibly bypass such complications. Our case exemplifies the consideration of catheter-directed embolectomy as the initial treatment modality of a hemodynamically unstable gestational PE.

Keywords

thrombectomy - embolectomy - thrombolytic therapy - pregnancy - pulmonary embolism


Publication History

Received: 10 December 2023

Accepted: 27 March 2024

Accepted Manuscript online:
04 April 2024

Article published online:
10 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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