Use of Extracorporeal Membrane Oxygenation in Postpartum Management of a Patient with Pulmonary Arterial Hypertension

Current guidelines do not recommend pregnancy in patients with pulmonary arterial hypertension (PAH). This is due to the associated high mortality, which both dissuades PAH patients from becoming pregnant and encourages termination of pregnancy due to high maternal mortality risk. As a result, there is a lack of data and, consequently, there are only general guidelines available for management of pregnancy in PAH patients. Additionally, novel therapeutic strategies such as extracorporeal membrane oxygenation (ECMO), although used in the management of nonpregnant PAH patients as a bridge to lung transplantation, have not been used to treat cardiopulmonary collapse in pregnant PAH patients. In an attempt to bridge this paucity of data, we report the successful use of ECMO in resuscitation and management of a pregnant PAH patient who experienced cardiopulmonary collapse following a caesarian section

Use of Extracorporeal Membrane Oxygenation in Postpartum Management of a Patient with Pulmonary Arterial Hypertension

Current guidelines do not recommend pregnancy in patients with pulmonary arterial hypertension (PAH). This is due to the associated high mortality, which both dissuades PAH patients from becoming pregnant and encourages termination of pregnancy due to high maternal mortality risk. As a result, there is a lack of data and, consequently, there are only general guidelines available for management of pregnancy in PAH patients. Additionally, novel therapeutic strategies such as extracorporeal membrane oxygenation (ECMO), although used in the management of nonpregnant PAH patients as a bridge to lung transplantation, have not been used to treat cardiopulmonary collapse in pregnant PAH patients. In an attempt to bridge this paucity of data, we report the successful use of ECMO in resuscitation and management of a pregnant PAH patient who experienced cardiopulmonary collapse following a caesarian section

Treatment of Pulmonary Hypertension in POEMS Syndrome with Autologous Stem Cell Transplantation

POEMS, a rare paraneoplastic syndrome, can cause pulmonary hypertension (PH). PH, diagnosed through echocardiogram in patients with POEMS, is known to improve after autologous stem cell transplantation (ASCT). However, similar accounts of PH, diagnosed through right heart catheterization (RHC), the gold standard diagnostic test for PH, do not exist. We report the case of a 65-year-old female who presented with dyspnea and burning pain in feet. Physical examination was unremarkable, while basic investigations revealed an elevated protein-albumin gap. This prompted further tests that led to the diagnosis of POEMS syndrome. Echocardiogram was additionally obtained and raised concern for PH. RHC was hence performed and confirmed the diagnosis of PH secondary to POEMS syndrome. The patient was treated with ASCT following which her dyspnea got better and repeated RHC revealed improved hemodynamics. This report highlights the first case of PH secondary to POEMS syndrome, which demonstrated improvement in hemodynamics, measured by RHC, following ASCT.</jats:p