Clinical Analysis Of 9 Patients Of Maternal Combined With Pulmonary Vascular Diseases

Objective:Patients of maternal combined with pulmonary vascular diseases are often extremely dangerous with high mortality.The clinical manifestations are nonspecific and often take dyspnea as the first symptom.The clinical data of 9 patients of maternal combined with pulmonary vascular diseases was collected,summarizing the clinical manifestations,laboratory tests,imaging performance,treatment and disease outcomes,etc to improve the understanding of the diseases and reduce the mortality.Methods:Collect the information of 7 pregnant women and 2 postpartum women combined with pulmonary vascular diseases who were admitted in Sir Run Run Shaw Hospital from January 2013 to December 2017.Analyze their general conditions,clinical features,laboratory tests,echocardiography,CTPA,V/Q scanning,treatments,and outcomes retrospectively.Results:Of the 9 patients of maternal combined with pulmonary vascular diseases,4 were diagnosed as pulmonary embolism,4 were pulmonary arterial hypertension,and 1 was pulmonary arteriovenous malformation.There were 9 cases of dyspnoea,5 cases of cough,2 cases of haemoptysis,2 cases of chest pain and 2 cases of leg pain.There were also 4 cases of shortness of breath(>20 times/min),4 cases of heart rate increased(>110 times/min),2 cases of valvular murmur,2 cases of accentuated pulmonary component of the second heart sound,3 cases of edema of lower limbs and 1 case of acropachy.There wre 7 cases of type I respiratory failure,3 cases of hypocapnia,8 cases of lactic acid increased,all cases of elevated D-dimer levels,6 cases of elevated NT-proBNP and 2 cases of elevated Troponin I.The echocardiographies showed 5 cases of right heart enlargement,2 cases of left heart enlargement,6 cases of pulmonary arterial hypertension and 4 cases of hydropericardium.CT or CTPA showed 3 cases of pulmonary artery broadening,2 cases of right heart enlargement,5 cases of pulmonary effusion,4 cases of hydrothorax and 2 cases of hydropericardium.6 cases recoveried after treatment and the last 3 died.Conclusion:Patients of maternal combined with pulmonary vascular diseases are extremely dangerous with high sudden death and mortality.They have no specific symptoms and signs,and dyspnea is common.Once there is any unexplained acute dyspnea,firstly consider the possibility of pulmonary vascular diseases and echocardiography is the routine examination.Patients of maternal combined with pulmonary vascular diseases should be analyzed from the perspective of the maternal and infant safety.Analyze comprehensively according to each patient's own situation,and develop appropriate diagnosis and treatment means.