title: Early postpartum mitral valve thrombosis requiring extra corporeal membrane oxygenation before successful valve replacement.
abstract: Pregnancy is associated with an increased risk of thrombosis in women with mechanical prosthetic heart valves. We present the case of a 29-year-old woman who developed early postpartum mitral valve thrombus after an elective cesarean delivery. The patient had a mechanical mitral valve and was treated with warfarin in the second trimester, which was replaced with high-dose dalteparin during late pregnancy. Elective cesarean delivery was performed under general anesthesia at 37weeks of gestation. The patient was admitted to the intensive care unit for postoperative care and within 30min she developed dyspnea and hypoxia requiring mechanical ventilation. She deteriorated rapidly and developed pulmonary edema, worsening hypoxia and severe acidosis. Urgent extra corporeal membrane oxygenation was initiated. Transesophageal echocardiography revealed a mitral valve thrombus. The patient underwent a successful mitral valve replacement after three days on extra corporeal membrane oxygenation. This case highlights the importance of multidisciplinary care and frequent monitoring of anticoagulation during care of pregnant women with prosthetic heart valves.
authors.affiliation: Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Sweden; Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. Electronic address: halla.halldorsdottir@karolinska.se.
authors.forename: H
authors.initials: H
authors.lastname: Halldorsdottir
authors.affiliation: Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Nordström
authors.affiliation: Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Sweden; Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Brattström
authors.affiliation: Department of Obstetrics and Gynecology, Karolinska University Hospital Solna, Sweden.
authors.forename: M M
authors.initials: MM
authors.lastname: Sennström
authors.affiliation: Department of Cardiothoracic Surgery, Karolinska University Hospital Solna, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Sartipy
authors.affiliation: Department of Cardiology, Karolinska University Hospital Solna, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Mattsson
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006349:Heart Valve Diseases / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000628:therapy*; D013927:Thrombosis / Q000628:therapy*
chemical_list: D006495:Heparin, Low-Molecular-Weight
keywords: Cesarean section; Extra corporeal membrane oxygenation; Mitral valve replacement; Mitral valve thrombus