ABC | Volume 111, Nº4, Octuber 2018

Anatomopathological Correlation Ávila et al. Mechanical cardiac prosthesis, pregnancy and respiratory failure and shock Arq Bras Cardiol. 2018; 111(4):629-634 Figure 1 – Admission ECG: sinus rhythm with indirect signs of left atrial overload and right atrial overload (Peñaloza-Tranquesi). Figure 2 – Admission chest x-ray: signs of congestion and pulmonary infection (air bronchogram). even underestimated, since it was difficult to determine its full extent using the two-dimensional methodology, reached values of 0.9 x 1.3 cm, resulting in an area of 1.17 cm² (important when > 0.8 cm²) and, thus, the surgical intervention was indicated, since it was available at the service (Table 1). Given the echocardiographic diagnosis of mitral valve prosthesis thrombosis, surgical treatment of the mitral valve was indicated, despite the gestational age, due to the high risk of maternal death. Intravenous unfractionated heparin was then started in an infusion pump while awaiting the surgical procedure. During this period, the patient developed a new picture of marked dyspnea, with marked congestion (Figure 3), tachycardia, and fever, requiring invasive ventilatory support with orotracheal intubation, and hypotension requiring vasopressor agent (noradrenaline). She went into cardiorespiratory arrest for 6 minutes, with spontaneous circulation and frank shock, requiring high doses of noradrenaline, adrenaline and vasopressin. She remained in shock and, despite the measures, presented with bradycardia and asystole and died (7h22; June 18, 2018). (Dr. Walkíria Samuel Ávila) 630