search for


Successful use of extracorporeal membrane oxygenation during cesarean section in parturients with symptomatic severe pulmonary stenosis: a case report
Med Biol Sci Eng 2019;2(2):46-50
Published online July 31, 2019
© 2019 Medical Biological Science and Engineering.

Doo-Hwan Kim, Gi-Ho Koh, Sang-A Lee, Young-Kug Kim, Dong-Min Jang

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Correspondence to: Dong-Min Jang
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3010-5308
Fax: +82-2-3010-6790
Received January 10, 2019; Revised April 9, 2019; Accepted April 10, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Optimizing anesthetic management during cesarean section in parturients with severe pulmonary stenosis is difficult. This report describes the use of extracorporeal membrane oxygenation (ECMO) in a patient with symptomatic severe pulmonary stenosis undergoing cesarean section. A 33-year-old primigravid woman was admitted to the emergency department during the 37th week of gestation for vaginal leakage and dyspnea on exertion. Transthoracic echocardiography showed severe pulmonary valve stenosis with a maximal gradient of 135 mmHg, combined with right ventricular hypertrophy and moderately decreased right ventricular contractility. She underwent emergency cesarean section under general anesthesia with ECMO as an adjuvant anesthetic method. Hemodynamic variables were well-maintained in the perioperative period, and the baby was delivered without complications. The patient was successfully weaned off of the ECMO device 3 hours after the end of the operation. The mother and baby were discharged in good health on hospital day 6. General anesthesia with ECMO support can be safe and effective in patients with severe pulmonary stenosis undergoing cesarean section.
Keywords : Cesarean section; Extracorporeal membrane oxygenation; Pregnant woman; Pulmonary valve stenosis; General anesthesia
  1. Dob DP, Yentis SM. Practical management of the parturient with congenital heart disease. Int J Obstet Anesth 2006;15:137-44.
    Pubmed CrossRef
  2. Connolly KM, McGuirt WF Jr. Elective extracorporeal membrane oxygenation: an improved perioperative technique in the treatment of tracheal obstruction. Ann Otol Rhinol Laryngol 2001;110:205-9.
    Pubmed CrossRef
  3. Huang SC, Wu ET, Chi NH, Chiu SN, Huang PM, Chen YS, et al. Perioperative extracorporeal membrane oxygenation support for critical pediatric airway surgery. Eur J Pediatr 2007;166:1129-33.
    Pubmed CrossRef
  4. Odonkor PN, Stansbury L, Garcia JP, Rock P, Deshpande SP, Grigore AM. Perioperative management of adult surgical patients on extracorporeal membrane oxygenation support. J Cardiothorac Vasc Anesth 2013;27:329-44.
    Pubmed CrossRef
  5. Brickner ME, Hillis LD, Lange RA. Congenital heart disease in adults. First of two parts. N Engl J Med 2000;342:256-63.
    Pubmed CrossRef
  6. Campbell N, Rosaeg OP, Chan KL. Anaesthetic management of a parturient with pulmonary stenosis and aortic incompetence for Caesarean section. Br J Anaesth 2003;90:241-3.
    Pubmed CrossRef
  7. Makkar JK, Jindal S, Jain A, Wig J. Anaesthetic management of a parturient with severe pulmonary stenosis undergoing Caesarean section. S Afr J Anaesthesiol Analg 2010;16:28-30.
  8. Sanikop CS, Umarani VS, Ashwini G. Anaesthetic management of a patient with isolated pulmonary stenosis posted for caesarean section. Indian J Anaesth 2012;56:66-8.
    Pubmed CrossRef
  9. Ransom DM, Leicht CH. Continuous spinal analgesia with sufentanil for labor and delivery in a parturient with severe pulmonary stenosis. Anesth Analg 1995;80:418-21.
    Pubmed CrossRef
  10. Cunningham JA, Devine PC, Jelic S. Extracorporeal membrane oxygenation in pregnancy. Obstet Gynecol 2006;108:792-5.
    Pubmed CrossRef
  11. Di Lorenzo G, Martucci G, Sciacca S, Longo R, Pilato M, Arcadipane A. Dysfunction of mechanical mitral prosthesis at 33rd week of pregnancy: ECMO support as a complex strategy for the mother and the fetus. Perfusion 2016;31:611-3.
    Pubmed CrossRef
  12. Łysenko L, Zaleska-Dorobisz U, Blok R, Dumański A, Zielińska M, Kustrzycki W, et al. A successful cesarean section in a pregnant woman with A (H1N1) influenza requiring ECMO support. Kardiochir Torakochirurgia Pol 2014;11:216-9.
    Pubmed CrossRef
  13. Panarello G, D’Ancona G, Capitanio G, Occhipinti G, Attardo G, Bertani A, et al. Cesarean section during ECMO support. Minerva Anestesiol 2011;77:654-7.
  14. Robertson LC, Allen SH, Konamme SP, Chestnut J, Wilson P. The successful use of extra-corporeal membrane oxygenation in the management of a pregnant woman with severe H1N1 2009 influenza complicated by pneumonitis and adult respiratory distress syndrome. Int J Obstet Anesth 2010;19:443-7.
    Pubmed CrossRef
  15. Sugioka J, Nakajima T, Ohsumi H, Kuro M, Sasako Y. [Anesthetic management using percutaneous cardiopulmonary support for cesarean section in a patient with severe pulmonary hypertension]. Masui 1995;44:574-8. Japanese.
  16. Hameed AB, Goodwin TM, Elkayam U. Effect of pulmonary stenosis on pregnancy outcomes--a case-control study. Am Heart J 2007;154:852-4.
    Pubmed CrossRef
  17. Hara R, Hara S, Ong CS, Schwartz G, Sciortino C, Hibino N. Cesarean section in the setting of severe pulmonary hypertension requiring extracorporeal life support. Gen Thorac Cardiovasc Surg 2017;65:532-4.
    Pubmed CrossRef
  18. Choi JH, Kim SW, Kim YU, Kim SY, Kim KS, Joo SJ, et al. Application of veno-arterial-venous extracorporeal membrane oxygenation in differential hypoxia. Multidiscip Respir Med 2014;9:55.
    Pubmed CrossRef
  19. Lamarche Y, Chow B, Bédard A, Johal N, Kaan A, Humphries KH, et al. Thromboembolic events in patients on extracorporeal membrane oxygenation without anticoagulation. Innovations (Phila) 2010;5:424-9.
    Pubmed CrossRef
  20. Arlt M, Philipp A, Voelkel S, Rupprecht L, Mueller T, Hilker M, et al. Extracorporeal membrane oxygenation in severe trauma patients with bleeding shock. Resuscitation 2010;81:804-9.
    Pubmed CrossRef
  21. Wen PH, Chan WH, Chen YC, Chen YL, Chan CP, Lin PY. Non-heparinized ECMO serves a rescue method in a multitrauma patient combining pulmonary contusion and nonoperative internal bleeding: a case report and literature review. World J Emerg Surg 2015;10:15.
    Pubmed CrossRef
  22. Moore SA, Dietl CA, Coleman DM. Extracorporeal life support during pregnancy. J Thorac Cardiovasc Surg 2016;151:1154-60.
    Pubmed CrossRef

July 2019, 2 (2)
Full Text(PDF) Free

Social Network Service

Cited By Articles
  • CrossRef (0)
  • Crossref
  • Google Scholar