Mechanical Valve Thrombosis in a Pregnant Woman: A Case Report
DOI:
https://doi.org/10.1532/HSF98.20091032Abstract
We report a case of metallic prosthetic valve thrombosis in a 24-year-old woman at her 36th week of gestation. With the onset of gestation this patient had been prescribed enoxaparin at a once-daily dose of 0.6 mL, which was lower than the recommended dose. The patient's mitral valve gradient was increased. We gave her intravenous unfractionated heparin because she refused to give consent for thrombolytic therapy owing to its potential hazards for the fetus. After the patient gave birth we treated her with a thrombolytic agent and the thrombus completely dissolved. Pregnancy in patients with mechanical valve prosthesis requires close follow-up and patient adherence to the prescribed medications. In case of thrombus formation both the fetus and the mother are at risk for fatal complications.References
Carroll AJ, Thorn SA. 2006. Heart disease in pregnancy. Medicine 34:307-11.nBehrendt P, Schwartzkopff G, Perings S, et al. 2002. Successful thrombolysis of St. Jude mechanical aortic prosthesis with tissue-type plasminogen activator in a pregnant woman: a case report. Cardiol Rev 10:349-53.nBonow RO, Carabello BA, Chatterjee K, et al. 2006. ACC/AHA 2006 practice guidelines for the management of patients with valvular heart disease: executive summary. J Am Coll Cardiol 48:598-675.nChan WS, Anand S, Ginsberg JS. 2000. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med 160:191-6.nDe Boer K, Ten Cate JW, Sturk A, et al. 1989. Enhanced thrombin generation in normal and hypertensive pregnancy. Am J Obstet Gynecol 160:95-100.nEdmunds LH Jr. 1982. Thromboembolic complications of current cardiac valvular prostheses. Ann Thorac Surg 34:96-106.nHanania G, Thomas D, Michel PL, et al. 1994. Pregnancy and prosthetic heart valves: a French cooperative retrospective study of 155 cases. Eur Heart J 15:1651-8.nKontos GJ Jr, Schaff HV, Orszulak TA, Puga FJ, Pluth JR, Danielson GK. 1989. Thrombotic obstruction of disc valves: clinical recognition and surgical management. Ann Thorac Surg 48:60-5.nLengyel M, Horstkotte D, Völler H, Mistiaen WP. 2005. Working Group Infection, Thrombosis, Embolism and Bleeding of the Society for Heart Valve Disease. Recommendations for the management of prosthetic valve thrombosis. J Heart Valve Dis 14:567-75.nLengyel M, Vandor L. 2001. The role of thrombolysis in the management of left-sided prosthetic valve thrombosis: a study of 85 cases diagnosed by transesophageal echocardiography. J Heart Valve Dis 10:636-49.nSadler L, McCowan L, White H, et al. 2000. Pregnancy outcomes and cardiac complications in women with mechanical, bioprosthetic and homograft valves. BJOG 107:245-53.nSahnoun-Trabelsi I, Jimenez M, Choussat A, Roudaut R. 2004. Prosthetic valve thrombosis in pregnancy. a single-center study of 12 cases. Arch Mal Coeur Vaiss 97:305-10.nThorburn CW, Morgan JJ, Shanahan MX, Chang VP. 1983. Long-term results of tricuspid valve replacement and the problem of prosthetic valve thrombosis. Am J Cardiol 51:1128-32.n
