Peripartum Heart Failure due to Primary Pulmonary Hypertension: Two Case Reports

Objective: Primary pulmonary hypertension (PPH) with pregnancy can result in peripartum heart failure and a high mortality rate. We report two cases of fatal PPH in pregnant women. Case Reports: From July 1992 to July 2002, two pregnant women with PPH were treated in our hospital. Case 1 was a 24-year-old primigravida, referred to our institution at 33 weeks of gestation because of signs of heart failure. She delivered a male baby by emergency cesarean section under general anesthesia. Five hours later, she developed severe systemic hypotension and died of cardiovascular collapse despite aggressive treatment and intensive care. Case 2 was a 29-year-old para 0 gravida 1 woman. She had been transferred to our hospital at 34 weeks of gestation, when fatigue, increasing dyspnea, orthopnea, tachycardia, chest pain, and peripheral cyanosis were found in our emergency department. She delivered a male baby by cesarean section under general anesthesia. Four hours later, she suddenly developed cyanosis and tachycardia, followed by electromechanical dissociation. All attempts at resuscitation were unsuccessful, and cardiac arrest ensued. Conclusion: We suggest that cesarean section be carried out with the help of the intensive care unit since transportation of the patient from the operating theatre to the intensive care unit is time-consuming and may result in deterioration of the patient's condition. A multidisciplinary team approach to management in the second trimester may reduce the high mortality rate.