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Case Reports
. 2022 Nov 1;6(11):ytac424.
doi: 10.1093/ehjcr/ytac424. eCollection 2022 Nov.

The multidisciplinary management of a mechanical mitral valve thrombosis in pregnancy: a case report and review of the literature

Jennifer M Wright  1 , Natalie Bottega  1 , Judith Therrien  2 , Roupen Hatzakorzian  3   4 , Jean Buithieu  1 , Dominique Shum-Tim  5 , Karen Wou  6 , Amale Ghandour  5 , Patricia Pelletier  1 , William Li Pi Shan  3 , Ian Kaufman  3 , Richard Brown  6 , Isabelle Malhamé  1   7
Affiliations
Case Reports

The multidisciplinary management of a mechanical mitral valve thrombosis in pregnancy: a case report and review of the literature

Jennifer M Wright et al. Eur Heart J Case Rep. .

Abstract

Background: The management of anticoagulation for mechanical heart valves during pregnancy poses a unique challenge. Mechanical valve thrombosis is a devastating complication for which surgery is often the treatment of choice. However, cardiac surgery for prosthetic valve dysfunction in pregnant patients confers a high risk of maternofetal morbidity and mortality.

Case summary: A 39-year-old woman in her first pregnancy at 30 weeks gestation presented to hospital with a mechanical mitral valve thrombosis despite therapeutic anticoagulation with low-molecular-weight heparin. She underwent an emergent caesarean section followed immediately by a bioprosthetic mitral valve replacement. This occurred after careful planning and organization on the part of a large multidisciplinary team.

Discussion: A proactive, rather than reactive, approach to the surgical management of a mechanical valve thrombosis in pregnancy will maximize the chances of successful maternal and fetal outcomes.

Keywords: Case report; Low-molecular-weight heparin; Mechanical heart valve; Pregnancy; Surgery; Thrombosis; Warfarin.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Mechanical heart valve mass on echocardiography. Transthoracic echocardiography [parasternal long axis (PLAX) view] showing the large multilobed thrombus on ventricular surface of the bi-leaflet metallic mitral valve. LV = left ventricle, MV = mitral valve, LA = left atrium, RV = right ventricle.
Figure 2
Figure 2
Mechanical mitral valve thrombus. Surgical specimen of the mass resected from the patient’s mechanical mitral valve. It measured 3.5 × 1.5 × 1.5 cm on the ventricular side and a 2.3 × 1 × 1 cm on the atrial side. A thrombus was confirmed upon pathological examination.
None
See this image and copyright information in PMC

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