Acute thrombosis of a prosthetic mitral valve in pregnancy in spite of adjusted-dose low-molecular-weight heparin and aspirin.
A 31-year-old primigravida had a 27-mm CarboMedics mitral valve implanted previously for mitral regurgitation. The patient had decided to take low-molecular-weight heparin (LMWH) and aspirin throughout her pregnancy. Monthly echocardiography and anti-Factor Xa levels were satisfactory. She presented at 36 weeks' gestation with 24 h of exertional dyspnea, and was in pulmonary edema. Transthoracic echocardiography suggested valve thrombosis. The patient underwent mitral valve replacement after the vaginal delivery of a healthy infant. The resected valve was found to have adherent fresh thrombus. The recent recommendation that LMWH plus aspirin might provide adequate anticoagulation for mechanical valves in pregnancy does not prevent acute prosthetic mitral valve thrombosis.
Curtis
Stephanie L
SL
Bristol Congenital Heart Unit, Bristol Royal Infirmary, Bristol, UK.
Trinder
Johanna
J
Stuart
A Graham
AG
D000328:Adult; D001241:Aspirin / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D001241:Aspirin