Thrombotic pulmonary embolism of inferior vena cava during caesarean section: A case report and review of the literature

BACKGROUND

Thrombotic pulmonary embolism (TPE) is one of the most critical diseases in obstetrics but is rarely reported in caesarean section (CS) because TPE patients in CS have a high risk of death and are difficult to diagnose. This case report of TPE during CS was recorded by transthoracic echocardiography (TTE) and can provide a reference for the differential diagnosis of critical illnesses in CS.

CASE SUMMARY

A 37-year-old pregnant woman with rheumatic heart disease (RHD), gravida 5 and para 1 (G5P1), presented for emergency CS at 33 wk and 3 d of gestation under general anesthesia because of acute heart failure, pulmonary hypertension and arrhythmia. After placental removal during CS, TTE revealed a nascent thrombus in the inferior vena cava (IVC) that elongated, detached and fragmented leading to acute thromboembolic events and acute TPE. This report presents the whole process and details of TPE during CS and successful rescue without any sequelae in the patient. This case gives us new ideas for the diagnosis of death or cardiovascular accidents during CS in pregnant women with heart disease and the detailed presentation of the rapid development of TPE may also elucidate new ideas for treatment. This case also highlighted the importance of prophylactic anticoagulation in the management of heart disease during pregnancy.

CONCLUSION

Pregnancy with heart failure could trigger inferior vena cava (IVC)-origin TPE during CS. Detection and timely treatment can avoid serious consequences.

Analytical methods for braided stents design and comparison with FEA

Braiding technology is nowadays commonly adopted to build stent-like devices. Indeed, these endoprostheses, thanks to their typical great flexibility and kinking resistance, find several applications in mini-invasive treatments, involving but not limiting to the cardiovascular field. The design process usually involves many efforts and long trial and error processes before identifying the best combination of manufacturing parameters. This paper aims to provide analytical tools to support the design and optimization phases: the developed equations, based on few geometrical parameters commonly used for describing braided stents and material stiffness, are easily implementable in a worksheet and allow predicting the radial rigidity of braided stents, also involving complex features such as multiple twists and looped ends, and the diameter variation range. Finite element simulations, previously validated with respect to experimental tests, were used as a comparator to prove the reliability of the analytical results. The illustrated tools can assess the impact of each selected parameter modification and are intended to guide the optimal selection of geometrical and mechanical stent proprieties to obtain the desired radial rigidity, deliverability (minimum diameter), and, if forming processes are planned to modify the shape of the stent, the required diameter variations (maximum and minimum diameters).