High-risk pulmonary embolism in pregnancy

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Pulmonary embolism (PE) is one of the leading causes of maternal mortality worldwide. Treatment of PE in pregnancy and early postpartum is significantly complicated by high risk of bleeding, changes in hemostasis and hemodynamics, and fetal factors. Thrombolysis is the preferable method of reperfusion therapy in life threatening PE in pregnancy, but it is associated with extremely high risk of bleeding in early postpartum period. Therefore, it is necessary to find alternative methods of pulmonary artery reperfusion and stabilization using modern techniques of mechanical circulatory support. The data on the use of endovascular treatment and venoarterial extracorporeal membrane oxygenation (VA-ECMO) in PE in pregnant and postpartum women are extremely limited. This article presents a review of the latest technologies in the treatment of high-risk PE in pregnant women based on the clinical observation of the intensive care unit patients with myocardial infarction at N.I. Pirogov City Clinical Hospital No.1, Moscow City Health Department, Moscow.

Conclusion: An important question that needs to be addressed is when the use of ECMO in patients with PE, even during pregnancy, should be considered. Based on the available experience in the modern world, there are the following main indications: circulatory arrest, refractory cardiogenic obstructive shock, especially when reperfusion therapy is contraindicated or associated with a high risk of bleeding (early after caesarean section, thrombolytic therapy).

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作者简介

Aleksandra Shilova

N.I. Pirogov City Clinical Hospital No.1, Moscow City Health Department

编辑信件的主要联系方式.
Email: a.s.shilova@gmail.com
ORCID iD: 0000-0002-4092-5222

PhD, Head of the Regional Vascular Center

俄罗斯联邦, Moscow

Mikhail Ketskalo

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: m_ketskalo@oparina4.ru
ORCID iD: 0000-0001-6569-2106

PhD, Director of the NMRC for Anesthesiology and Resuscitation (for pregnant women)

俄罗斯联邦, Moscow

Evgeniy Ploshchenkov

N.I. Pirogov City Clinical Hospital No.1, Moscow City Health Department

Email: Jenya-09@inbox.ru
ORCID iD: 0009-0007-4694-6140

Head of the Department of X-ray Surgical Methods of Diagnosis and Treatment No. 1

俄罗斯联邦, Moscow

Murat Raimov

N.I. Pirogov City Clinical Hospital No.1, Moscow City Health Department

Email: mraimov@gmail.com
ORCID iD: 0009-0007-4952-4015

Anesthesiologist & Intensive Care Specialist, Head of the ICU Department for patients with acute myocardial infarction

俄罗斯联邦, Moscow

David Vachnadze

N.I. Pirogov City Clinical Hospital No.1, Moscow City Health Department

Email: dr@vachnadze.ru
ORCID iD: 0000-0003-0482-3795

Anesthesiologist & Intensive Care Specialist, ICU Department for patients with acute myocardial infarction

俄罗斯联邦, Moscow

Daniil Troitskiy

N.I. Pirogov City Clinical Hospital No.1, Moscow City Health Department

Email: troickijd@gmail.com
ORCID iD: 0000-0002-1181-518X

Anesthesiologist & Intensive Care Specialist, ICU Department for patients with acute myocardial infarction

俄罗斯联邦, Moscow

Natalia Samostrol

N.I. Pirogov City Clinical Hospital No.1, Moscow City Health Department

Email: Samostrol1992@gmail.com
ORCID iD: 0009-0002-7297-6638

Anesthesiologist & Intensive Care Specialist, ICU Department for patients with acute myocardial infarction

俄罗斯联邦, Moscow

Nina Rozina

N.I. Pirogov City Clinical Hospital No.1, Moscow City Health Department

Email: rozina.nina@gmail.com
ORCID iD: 0000-0002-0577-633X

Anesthesiologist & Intensive Care Specialist, ICU Department for patients with acute myocardial infarction

俄罗斯联邦, Moscow

Ekaterina Gilyarova

N.I. Pirogov City Clinical Hospital No.1, Moscow City Health Department

Email: gilarovae@gmail.com
ORCID iD: 0000-0002-5598-855X

Cardiologist, ICU Department for patients with acute myocardial infarction

俄罗斯联邦, Moscow

Roman Georgiev

N.I. Pirogov City Clinical Hospital No.1, Moscow City Health Department

Email: georgievra@gmail.com
ORCID iD: 0009-0002-2872-2497

Interventional Cardiologist, Department of X-ray Surgical Methods of Diagnosis and Treatment No. 1

俄罗斯联邦, Moscow

Artem Chernikov

N.I. Pirogov City Clinical Hospital No.1, Moscow City Health Department

Email: chernikovtema@mail.ru
ORCID iD: 0009-0000-0492-9878

Cardiologist, ICU Department for patients with acute myocardial infarction

俄罗斯联邦, Moscow

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2. Fig. 1. MSCT angiopulmonography of the left (1) and right (2) pulmonary artery

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3. Fig. 2. Angiography of the left uterine artery with extravasation of contrast agent (left) and the condition after selective embolization (right)

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