An intracardiac thrombus as a cause of cardiac arrest during a cesarean delivery

A 25-year-old, G6P1AA5 (G6: pregnancy 6 times, P1: parturition once, AA 5: artificial abortion 5 times), 37-week pregnant woman with a body mass index of 35 kg/m ² , 1 previous cesarean delivery, and no major disease, such as diabetes mellitus, hypertension, myocarditis, and cardiac arrhythmia history, was delivered via cesarean delivery because of breech presentation. During the administration of spinal anesthesia, her spinal level reached T4, and her hemodynamics were stable. She tolerated the delivery well and could have occasional small talks with the medical team during cesarean delivery. Her blood loss was approximately 500 mL.

Immediately after the delivery of the newborn, significant bradycardia was detected through the monitors. The patient’s heart rate dropped from 70 beats per minute (bpm) to 40 bpm. We checked her consciousness, and her poor response was noted. Atropine 1 mg was immediately prescribed, but her blood pressure remained low at 50/20 mm Hg. After administering 1 mg of epinephrine and volume loading, we started chest compression to maintain adequate cardiac output. Neither obvious active blood loss nor rash or abnormal airway pressure was noted. An emergency transesophageal echocardiography (TEE) ( Video ) was performed for further diagnosis.

A series of thrombi were seen along the right side of the heart, resulting in right ventricle (RV) outflow obstruction and right heart failure ( Figures 1–4 ).