Emergency Redo Mitral Valve Replacement Immediately after Caesarean Section

Abstract

Surgery for heart diseases during pregnancy, especially necessitating cardiopulmonary bypass, is believed to trigger maternal and fetal risks and should be performed only when medical therapy has been unsuccessful to alleviate the cardiac decompensation. A 33-year-old pregnant woman in her 33rd week of gestation was admitted to our hospital. She had rheumatic mitral valvular stenosis and had undergone mitral valve replacement (MVR) with a mechanical prosthesis 11 years earlier in another center. Echocardiography revealed a thrombotic mass obstructing the leaflets of the mechanical mitral valve. Emergency redo bioprosthetic MVR concomitant with caesarean section was performed uneventfully. Both mother and baby were discharged in good condition.

Keywords: Caesarean section; Emergencies; Mitral valve; Pregnancy; Reoperation.

Figure 1

Transthoracic echocardiography reveals the obstruction of the prosthetic mitral valve with a mean diastolic mitral transvalvular gradient of 23 mm Hg and a peak velocity of 3.36 m/s.

Figure 2

Intraoperative view of the stuck mechanical valve is illustrated in the mitral position through left atriotomy.

Figure 3

Resected view of the stuck mechanical mitral valve is presented.