title: Premeditated reoperation after mitral valve replacement with a Starr-Edwards ball valve for young women who desire to bear a child: report of two cases.
abstract: There are many difficulties for young women with a Starr-Edwards ball valve who want to attempt pregnancy. There is no consensus regarding whether they should maintain anticoagulation therapy throughout pregnancy with the risk of a thromboembolism or to undergo a reoperation with bioprosthetic heart valves, followed by a third operation when the valve deteriorates. This report presents two cases of young women who underwent mitral valve replacement (MVR) with Starr-Edwards ball valves (model 6120: 1M) during their childhood. Although they did not have any cardiac symptoms, transthoracic echocardiography and cardiac catheterization data demonstrated that both the patients had asymptomatic mild relative mitral stenosis. They both wished to bear a child. After the patients and their family provided thorough informed consent, redo MVRs were preformed safely with biological prostheses. The presence of significant pannus formation along the strut and sewing ring of the excised valves could also have a positive impact on the decision to undergo reoperation.
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, Arakawa-ku, Tokyo, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Asano
authors.forename: Kiyoharu
authors.initials: K
authors.lastname: Nakano
authors.forename: Kojiro
authors.initials: K
authors.lastname: Kodera
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Murai
authors.forename: Akihito
authors.initials: A
authors.lastname: Sasaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ikeda
authors.forename: Go
authors.initials: G
authors.lastname: Kataoka
authors.forename: Akiko
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Satoru
authors.initials: S
authors.lastname: Domoto
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Takeuchi
mesh_terms: D000328:Adult; D001705:Bioprosthesis; D020878:Device Removal; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000175:diagnosis; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000517:prevention & control*; D012086:Reoperation; D013923:Thromboembolism / Q000517:prevention & control*; D014463:Ultrasonography