title: Sudden cardiac arrest during emergency caesarean delivery in a 31-year-old woman, due to accelerated structural valve degeneration of an aortic valve bioprosthesis.
abstract: The choice of prosthetic valve to implant in women of childbearing age requiring a valve replacement is challenging. Mechanical valves mandate the use of oral anticoagulation (OAC) for the prevention of thromboembolic complications, but the use of OAC during pregnancy can lead to maternal and fetal complications, in particular, warfarin embryopathy. Conversely, the use of bioprosthetic valves during pregnancy eliminates the need for OAC, but can instead be associated with accelerated structural valve degeneration. We present the case of a 31-year-old woman with a bioprosthetic valve in the aortic position, who developed undetected accelerated structural valve degeneration 5.5 years following implantation of a Mitroflow bioprosthetic aortic valve, and who suffered a catastrophic complication during emergency caesarean delivery as a result.
authors.affiliation: Department of Cardiology, Stadtspital Triemli, Zurich, Switzerland.
authors.forename: Crochan John
authors.initials: CJ
authors.lastname: O'Sullivan
authors.affiliation: Department of Cardiology, Stadtspital Triemli, Zurich, Switzerland.
authors.forename: Eva
authors.initials: E
authors.lastname: Bühlmann Lerjen
authors.affiliation: Department of Pathology, Stadtspital Triemli, Zurich, Switzerland.
authors.forename: Daniela
authors.initials: D
authors.lastname: Pellegrini
authors.affiliation: Department of Cardiology, Stadtspital Triemli, Zurich, Switzerland.
authors.forename: Franz Robert
authors.initials: FR
authors.lastname: Eberli
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001021:Aortic Valve / Q000473:pathology*; D001705:Bioprosthesis / Q000009:adverse effects*; D002585:Cesarean Section / Q000009:adverse effects*; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011475:Prosthesis Failure / Q000009:adverse effects*; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin