Acute respiratory İnsufficiency due to peripartum cardiomyopathy after caesarean section in a term pregnancy with twins
Küçük Resim Yok
Tarih
2010
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Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
İkiz gebeliği olan ve postoperatif dönemde kardiyomiyopatiye bağlı akut solunum yetmezliği gelişen bir olgu sunulmuştur. Bizim olgumuzda, 30 yaşında 32 haftalık ikiz gebeliği olan kadın hasta preterm membran rüptürü nedeniyle Kadın Hastalıkları ve Doğum kliniğine yatırıldı. Tokolizden 48 saat sonra genel anestezi altında hasta operasyona alındı. Uyandırma döneminde SpO2 %32 saptanan hastada taşikardi ve takipne gelişti. Oskültasyonda her iki akciğer alt zonda krepitan raller tespit edildi. Hasta pozitif basınçlı ventilasyona rağmen oksijen satürasyon yüzdesinin düşük seyretmesi ve siyanozunun devam etmesi nedeniyle, Yoğun Bakım Ünitesi’ne entübe halde alındı. Çekilen akciğer grafisinde, her iki akciğer alt loblarında pulmoner infiltratlar ve kalp gölgesinin genişlemiş olduğu tespit edildi. Ekokardiyografik incelemesinde ejeksiyon fraksiyonu %45, sol ventrikül sistolik disfonksiyonu, sol ventrikül boyutlarında artma, orta mitral kapak yetmezliği ve hafif triküspit kapak yetmezliği saptanan hastada, bu tabloyu açıklayacak anemi dışında bulgu saptanmadı. Peripartum kalp yetmezliği tanısı konan hastaya lisinopril ve furosemid başlandı. Postoperatif 4. günde hasta mekanik ventilatörden ayrıldı, postoperatif 7. günde taburcu edildi.
We report a case of acute respiratory insufficiency due to peripartum cardiomyopathy after Caesarean section in a term pregnancy with twins. The patient was a 30-year-old woman with a spontaneous twin pregnancy at 32 weeks of gestation who was admitted to our obstetrics department with preterm premature rupture of membranes. After 48 hours, the tocolysis was stopped and an uneventful Caesarean was performed under general anesthesia. As the patient was waking up, her SPO2 decreased to 32%, and she became cyanotic and tachypneic. Auscultation revealed rales in her lower lung lobes bilaterally. Her oxygen saturation did not increase in the hours that followed, and her cyanosis persisted, so we decided to admit her to the Intensive Care Unit. She was mechanically ventilated. Her chest Xray showed an enlarged cardiac silhouette and pulmonary infiltrates in the lower lobes. On the second postoperative day, transthoracic echocardiography was performed and revealed an EF of 45%, mild left ventricular systolic dysfunction and moderate mitral valve failure. Lisinopryl and furosemide were started. On postoperative day four, her symptoms and radiological signs had resolved. She was weaned from mechanical ventilation and discharged from the obstetric ward on postoperative day seven.
We report a case of acute respiratory insufficiency due to peripartum cardiomyopathy after Caesarean section in a term pregnancy with twins. The patient was a 30-year-old woman with a spontaneous twin pregnancy at 32 weeks of gestation who was admitted to our obstetrics department with preterm premature rupture of membranes. After 48 hours, the tocolysis was stopped and an uneventful Caesarean was performed under general anesthesia. As the patient was waking up, her SPO2 decreased to 32%, and she became cyanotic and tachypneic. Auscultation revealed rales in her lower lung lobes bilaterally. Her oxygen saturation did not increase in the hours that followed, and her cyanosis persisted, so we decided to admit her to the Intensive Care Unit. She was mechanically ventilated. Her chest Xray showed an enlarged cardiac silhouette and pulmonary infiltrates in the lower lobes. On the second postoperative day, transthoracic echocardiography was performed and revealed an EF of 45%, mild left ventricular systolic dysfunction and moderate mitral valve failure. Lisinopryl and furosemide were started. On postoperative day four, her symptoms and radiological signs had resolved. She was weaned from mechanical ventilation and discharged from the obstetric ward on postoperative day seven.
Açıklama
Anahtar Kelimeler
Genel ve Dahili Tıp
Kaynak
Eurasian Journal of Medicine
WoS Q Değeri
Scopus Q Değeri
Cilt
42
Sayı
3
