Amniotic fluid embolism: a rare cause of acute left-sided heart failure.

Study design and setting - Two case reports, University Hospital of Antwerp, tertiary referral hospital of the University of Antwerp, Edegem, Belgium. Methods and results - Two women were transferred to our hospital because of acute cardio-respiratory failure due to amniotic fluid embolism during the peripartal period. Both required intensive supportive treatment and invasive monitoring. Haemodynamic data revealed primary left ventricular failure confirming the clinical picture of cardiogenic pulmonary oedema. Review of the literature provides data that do not support obstruction of the pulmonary vasculature by amniotic fluid as the only primary pathophysiological event. However, despite several case reports stressing left ventricular failure as the dominant clinical event, pathophysiological mechanisms are merely speculative. Conclusions - The diagnosis of amniotic fluid embolism remains a clinical challenge, but can be supported by the presence of amniotic cells in the pulmonary artery, aspirated through a pulmonary artery catheter. The treatment is still not causative but supportive. An overview of cases in the literature with predominant left heart failure during amniotic fluid embolism is given.