A successful pulmonary embolectomy was performed on a patient in her first trimester of pregnancy. The 21-year-old patient was hypotensive and had severe right ventricular failure from 75% obstruction of the pulmonary arterial circulation by thrombus. After pulmonary embolectomy and caval interruption she was delivered of a normal infant.
The incidence of pulmonary embolism during pregnancy is probably greater than commonly recognized. Pulmonary embolism on cardiopulmonary bypass should be considered in the small group of patients in whom there is the combination of right ventricular failure, prolonged systemic hypotension despite medical therapy, and pulmonary obstruction greater than 50% documented by angiography.