title: Prosthetic mitral valve thrombosis in pregnancy: from thrombolysis to anticoagulation.
abstract: BACKGROUND
  Pregnant women with mechanical prosthetic heart valves are at increased risk for valve thrombosis. Management decisions for this life-threatening complication are complex. Open-heart surgery has a very high risk of maternal mortality and fetal loss. Bleeding and embolic risks associated with thrombolytic agents, the limited efficacy of thrombolysis in certain subgroups, and a lack of experience in the setting of pregnancy raise important concerns.
  
  
  METHODS
  We report a case of mitral prosthetic valve thrombosis in early pregnancy, which was successfully treated with streptokinase. Ten years later, the same patient had an uneventful pregnancy, throughout which acenocoumarol was maintained.
  
  
  CONCLUSIONS
  With this case we review the prevention (with oral anticoagulant therapy) and treatment of prosthetic valve thrombosis during pregnancy, which is important for both obstetrician and cardiologist.
authors.affiliation: Department of Cardiology, Santa Cruz Hospital, CHLO, Carnaxide, Portugal. Electronic address: goncaloccardoso@gmail.com.
authors.forename: Gonçalo
authors.initials: G
authors.lastname: Cardoso
authors.affiliation: Department of Cardiology, Santa Cruz Hospital, CHLO, Carnaxide, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Aguiar
authors.affiliation: Department of Cardiology, Santa Cruz Hospital, CHLO, Carnaxide, Portugal.
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Andrade
authors.affiliation: Department of Cardiology, Santa Marta Hospital, CHLC, Lisbon, Portugal; High-risk Pregnancy Outpatient Clinic, Maternidade Alfredo da Costa, CHLC, Lisbon, Portugal.
authors.forename: Lino
authors.initials: L
authors.lastname: Patrício
authors.affiliation: Department of Clinical Pathology, São Francisco Hospital, CHLO, Lisboa, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Freire
authors.affiliation: Department of Gynecology and Obstetrics, Maternidade Alfredo da Costa, CHLC, Lisboa, Portugal.
authors.forename: Fátima
authors.initials: F
authors.lastname: Serrano
authors.affiliation: Department of Pediatric Cardiology, Santa Cruz Hospital, CHLO, Carnaxide, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Anjos
authors.affiliation: Department of Cardiology, Santa Cruz Hospital, CHLO, Carnaxide, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Mendes
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008943:Mitral Valve; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*; D015912:Thrombolytic Therapy
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Anticoagulação; Gravidez; Pregnancy; Thrombolysis; Trombose de prótese; Trombólise; Valve thrombosis