[Pregnancy in women with a mechanical heart valve. Review of the literature].
OBJECTIVE
To define therapeutic ways to manage obstetrics at an optimal level for a patient carrying a mechanical prosthetic heart valve.


METHODS
From a review of literature and documented cases, we propose an obstetrical and cardiological management scheme for pregnant patients carrying a mechanical prosthetic heart valve. We deal successively with the preventive (anticoagulation) and curative treatment (surgery and thrombolytic therapy) of valvular thrombosis, in fact, a severe -but unfortunately frequent- complication of these pregnancies.


RESULTS
Pregnancy concerning patients with mechanical prosthetic heart valves is a high-risk pregnancy. In fact, the risk of thrombo-embolic accidents even with a closely followed anticoagulant treatment seems to come from the existence of the prothese, the state of physiological hypercoagulation and peri-partum hemorrhages. Naturally, multidisciplinary follow-up is indispensable. The prescription of anticoagulant treatments must respect the main principals and the normal counter-indications in order to minimise maternal and fetal complications.


CONCLUSIONS
Pregnancy amongst patients carrying mechanical prosthetic heart valves should be considered rare and highly exceptional cases, from a cardio-vascular surgeon's point of view. For obstetricians, it is sometimes difficult to forbid pregnancy to a nullipara. The discussion whether to authorize a pregnancy will be treated case-by-case, holding into account the socio-cultural environment of the patient, as the principles of an anticoagulant treatment and the underlying risks must be well understood.
Berard
J
J
Service de Gynécologie-Obstétrique. Hôpital Jeanne de Flandre, Lille.
Dufour
P
P
Subtil
D
D
Vaksmann
S
S
Monier
E
E
Puech
F
F
Monnier
J C
JC
Codaccioni
X
X
D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D007231:Infant, Newborn; D010348:Patient Care Team; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology / Q000628:therapy*; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000628:therapy
D000925:Anticoagulants