Novel Insights from Clinical Experience

Serial Hemodynamics and Complications of Pregnancy in Severe Pulmonary Arterial Hypertension
Arby Nahapetian, Ronald J. Oudiz

Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, Calif., USA

Address of Corresponding Author

Cardiology 2008;109:237-240 (DOI: 10.1159/000107786)

  Key Words

• Pulmonary arterial hypertension
• Pregnancy

  Abstract

We report a case of a woman who became pregnant after the diagnosis of moderate to severe pulmonary hypertension and underwent successful full-term pregnancy. Pulmonary hemodynamics were monitored before pregnancy and in the peripartum period. The patient was followed closely by the cardiology and high-risk obstetric specialists in the outpatient setting until she underwent c-section with epidural anesthesia. Outpatient medical management included twice daily subcutaneous enoxaparin and once daily amlodipine. Immediately prior to cesarian section, and for several days postoperatively, invasive hemodynamic monitoring was employed to titrate medical therapy. During delivery, strict attention focused on limiting intravenous fluids in order to avoid right ventricular volume overload. The postoperative course was complicated by a spontaneous, acute rise in pulmonary vascular resistance, which was managed with intravenous epoprostenol. In addition, abdominal bleeding, likely related to postoperative anticoagulation and platelet dysfunction, was controlled with transfusion and spontaneously resolved after discontinuing the anticoagulation. This case presents a favorable outcome in a pregnant patient undergoing cesarian section despite several complications related to pulmonary hypertension and right ventricular dysfunction, which are often fatal.

Copyright © 2007 S. Karger AG, Basel

  Author Contacts

Ronald J. Oudiz, MD
Division of Cardiology
1124 W. Carson St. No. 405
Torrance, CA 90502 (USA)
Tel. +1 310 222 2515, Fax +1 310 787 0448, E-Mail oudiz@humc.edu

  Article Information

Received: February 8, 2007
Accepted: February 10, 2007
Published online: September 17, 2007
Number of Print Pages : 4
Number of Figures : 0, Number of Tables : 1, Number of References : 17