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Case report
Successful multimodality management of severe pulmonary arterial hypertension during pregnancy with VA-ECMO and atrial septostomy using stent
  1. Vorakamol Phoophiboon1,
  2. Nattapong Jaimchariyatam1,
  3. Suphot Srimahachota2 and
  4. Chayatat Sirinawin3
  1. 1Division of Pulmonology and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  2. 2Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
  3. 3Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  1. Correspondence to Dr Vorakamol Phoophiboon; rakamol{at}


A 30-year-old Thai woman (gravida 1, para 0) at 33 weeks gestation was referred to our hospital due to acute right ventricular failure. Pulmonary vasodilators were gradually administered before delivery. On the verge of sudden postpartum cardiac circulation collapse, she was resuscitated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Abdominal compartment syndrome was developed in the early period of the mechanical support. Knowledge of pathophysiology about pulmonary arterial hypertension during pregnancy was applied. Atrial septostomy was the effective procedure for discontinuing mechanical support (VA-ECMO) corresponding to the suitable timing for maximal effect of pulmonary vasodilators. The patient and her child were safe and discharged in 2 months after the admission.

  • interventional cardiology
  • pregnancy
  • cardiothoracic surgery
  • pulmonary hypertension

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  • Contributors VP, NJJ, SS and CS were the team of planning, conducting and reporting of the work described in the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.