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 4 – Great arteries of the heart showing patent ductus arteriosus (between the arrows). Despite the established supportive care, while waiting for the previously indicated definitive surgical therapy, the patient showed clinical deterioration and died, alerting us to the potential severity of a prosthesis thrombosis picture, which requires an emergency procedure (surgical or thrombolysis), regardless of aggravating factors such as the pregnancy itself or associated infections. (Dr. Vinícius Araújo de Freitas Chagas Caldas and Dr. Daniel Valente Batista) Diagnostic hypotheses: cardiogenic shock, acute pulmonary edema, thrombosis of the mechanical mitral prosthesis, systemic inflammatory response syndrome with possible pulmonary infectious focus. (Dr. Vinícius Araújo de Freitas Chagas Caldas and Dr. Daniel Valente Batista) Necropsy The gravid uterus contained an apparently well-formed fetus. The mother had a mild degree of pulmonary emphysema and significant alterations in the cardiovascular system, with a patent ductus arteriosus (Figure 4) measuring 2 mm in diameter; small interventricular septal defect (Figure 5); surgical sutures in the atrial septum, possibly corresponding to the defect closure; embolism (or thrombosis) of the left subclavian vein; and mechanical valve prosthesis in the mitral position, occluded by the presence of a thrombus-like mass in the two faces (Figure 6). Microscopic study confirmed the nature of this mass, with absence of microorganisms (Figure 7). There were small infarcts in the right kidney, possibly due to embolism caused by the prosthesis thrombus, and in the subendocardial region of the left ventricle. The lungs showed many alterations, almost in their entirety, with a histopathological pattern of organizing pneumonia (Figure 8). Furthermore, demonstrating congestion, there were macrophages containing hemosiderin, but not in large numbers; and dilation of lymphatic vessels. (Paulo Sampaio Gutierrez) Anatomopathological diagnoses: Congenital heart disease with interatrial defect, interventricular defect, patent ductus arteriosus, and thrombosis of the mechanical mitral valve. Cause of death: Mitral valve obstruction / organizing pneumonia (Dr. Paulo Sampaio Gutierrez) Figure 5 – Transversal section of the heart at the region of the ventricles showing a muscular ventricular septal defect (arrow). RV- right ventricle; LV- left ventricle. 632