A pregnant woman with partial anomalous pulmonary venous return complicated by hemoptysis: A case report

Abstract

　Pregnant women with congenital heart disease experience significant changes in circulatory dynamics as a result of increased circulating blood volume and cardiac output associated with pregnancy. We report a case of partial anomalous pulmonary venous return during pregnancy that developed into hemoptysis. The patient, a 36-year-old woman, was diagnosed with partial anomalous pulmonary venous return at the age of 19. She had hemoptysis during her last pregnancy and underwent bronchial artery embolization. At 34 weeks of pregnancy, she visited the emergency room due to hemoptysis and dyspneic sensation. At the time of arrival, she was unable to lie supine due to dyspnea. Blood test results indicated anemia, but coagulation was within normal limits. A chest CT scan showed that the right upper pulmonary vein flowed into an odd vein and the right main bronchus had a blood clot that almost completely occluded the lumen. We suspected that hemoptysis occurred due to increased pulmonary blood flow associated with partial anomalous pulmonary venous return in addition to the increased circulating blood volume and cardiac output associated with pregnancy. We judged the patient would have difficulty continuing her pregnancy, and an emergency Cesarean section was performed. Due to the patient's inability to lie supine due to respiratory distress and concerns about respiratory and circulatory changes associated with postoperative pain, general anesthesia with epidural anesthesia was selected as the anesthetic method. Intraoperative circulatory dynamics did not change significantly during the operation, and the surgery was completed successfully.