A report of a case: anesthetic management of a parturient with severe thrombotic stenosis of a mechanical aortic valve--an exercise in coordination of subspecialties.
The pregnant woman with valvular heart disease presents significant challenges to the obstetric, anesthesiology, and cardiology teams. Although successful outcomes for both mother and fetus are possible with coordinated medical care, the patient with a prosthetic valve who requires systemic anticoagulation provides a dilemma of insufficient anticoagulation leading to valve thrombosis versus the risks of maternal perinatal hemorrhage or fetal effects from oral or parenteral anticoagulants. This case report describes the peripartum management of a patient at 27 weeks' gestation with thrombus on a prosthetic aortic valve.
Inyang
Asuquo N
AN
Department of Anesthesiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA. ainyang@montefiore.org
Jackson
Mark
M
Kumar
Ashok
A
Nychka
Andre
A
Leyvi
Galina
G
Zhuravlev
Ilya
I
Plestis
Konstadinos
K
Wasnick
John
J
D000328:Adult; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D000925:Anticoagulants / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000150:complications*; D001037:Aphasia / Q000209:etiology; D003328:Coronary Thrombosis / Q000150:complications*; D005260:Female; D006350:Heart Valve Prosthesis; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D010348:Patient Care Team; D011183:Postoperative Complications / Q000523:psychology; D011247:Pregnancy
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight