title: Dysfunction of mechanical mitral prosthesis at 33rd week of pregnancy: ECMO support as a complex strategy for the mother and the fetus.
abstract: Pregnant women with mechanical prosthetic heart valves have an increased risk of thrombosis and valve malfunctioning. Surgery carries a high risk of mortality for the mother and the fetus. A strategy for effective anticoagulation is crucial for these patients because both oral anticoagulants and heparin are associated with high risks for the mother and the fetus. The treatment of a pregnant woman with thrombosis and valve malfunction is a challenge, even for multidisciplinary teams, as cardiac surgery carries considerable risks. We present a woman at her 33rd week of pregnancy affected by congestive cardiac decompensation due to mechanical mitral prosthesis dysfunction. Given the expanded indication for ECMO and the recent evidence of the procedure's increased safety, even in the peri-partum period, we centered the treatment on VA-ECMO initiation before a Cesarean section (C-section) to guarantee support during surgery and avoid excessive anticoagulation or hypoperfusion to the fetus and as a bridge to cardiac surgery two days later. The strategy resulted in a good outcome with no complications for the mother and the fetus and a reasonable length of stay.
authors.affiliation: Perfusion Service, Department of Anesthesia and Intensive Care, IRCCS-ISMETT, Palermo, Italy gdilorenzo@ismett.edu.
authors.forename: Gaspare
authors.initials: G
authors.lastname: Di Lorenzo
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS-ISMETT, Palermo, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Martucci
authors.affiliation: Department of Cardiothoracic Surgery, IRCCS-ISMETT, Palermo, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Sciacca
authors.affiliation: Perfusion Service, Department of Anesthesia and Intensive Care, IRCCS-ISMETT, Palermo, Italy.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Longo
authors.affiliation: Department of Cardiothoracic Surgery, IRCCS-ISMETT, Palermo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Pilato
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS-ISMETT, Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Arcadipane
mesh_terms: D002585:Cesarean Section / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy*; D011475:Prosthesis Failure / Q000009:adverse effects
keywords: HLS cannula; VA-ECMO; femoro-femoral bypass; multidisciplinary team; oxygenator PLS – Maquet