A Case of Delayed Diagnosis of Pulmonary Thromboembolism in a Patient with Mitral Stenosis Undergoing Cesarean Section

Cesarean section was performed under general anesthesia in a 38-year-old patient with congestive heart failure due to severe mitral stenosis. During surgery, pulmonary hypertension, right ventricular distension and the dissociation of PET_CO2 and Pa_CO2 were observed. However, pulmonary thromboembolism (PTE) was proved after the operation when she developed severe hypotension in the intensive care unit. Although she recovered once from circulatory unstability with the use of percutaneous cardiopulmonary support (PCPS) and she could be weaned from PCPS at the 4 th postoperative day, she died from tracheal bleeding and recurrent cardiopulmonary collapse 22 nd day after the surgery. It should be noted that the increasing dissociation of PET_CO2 and Pa_CO2 may be an early sign of PTE even in a patient with severe mitral stenosis and pulmonary hypertension.