Surgical treatment of pulmonary embolism in a 25-week pregnant woman

The use of a surgical embolectomy from the pulmonary artery is a promising and effective method of the surgical treatment of pulmonary embolism (PE) with a high risk of an early death during pregnancy. Surgical thrombectomy leads to the restoration of the patency of pulmonary arthery and the stabilization of condition of a patient. In this clinical case, the patient was urgently hospitalized in a clinic on August 5, 2019 with a diagnosis of PE with a high risk of mortality. VI pregnancy 25-26 weeks. The patient сomplained of the shortness of breath at rest to be sent at the slightest physical attachment, chest pain, general weakness, a feeling of rapid heartbeat, cyanosis in the face, rapid fatigue time. The echocardiography showed a regurgitation on the tricuspid valve, gradient up to 40 mmHg, dominant of the right departments. CT of the thoracic cavity showed massive thrombotic masses in the pulmonary artery. The thrombolytic therapy was not performed due to the high risk of bleeding. The operation was performed in an urgent order: thromboembolectomy from the pulmonary artery with an artificial circulation, plasticity of the tricuspid valve, suturing of the atrial septal defect. On the 16th day after surgery the patient was discharged home in a satisfactory condition. On November 13, 2019, the patient gave birth to a healthy child. Thus, despite the lack of clear guidelines for the use of surgical methods in the treatment of PE with a high risk of death during pregnancy, it can be argued that the use of surgical pulmonary artery embolectomy is an effective treatment. However, the small number of reports does not allow to make clear recommendations with a high level of evidence. Therefore, doctors must decide on the treatment tactics, taking the peculiarities of the pathology in each case individually into account. Further research will improve the evidence base and assist experts in making a decision.