Prosthetic heart valve thrombosis, anticoagulation and pregnancy: a case report and review of literature

Prosthetic heart valve thrombosis, anticoagulation and pregnancy: a case report and review of literature

In pregnant patients with a prosthetic heart valve (PHV), anticoagulation with warfarin is associated with embryopathy, foetal loss early in pregnancy and maternal bleeding complications in the delivery period. The optimal anticoagulation strategy in the pre-pregnancy period and during pregnancy itself is controversial and a matter of debate. We describe a patient with PHV in the pre-pregnancy period and in a subsequent pregnancy. The optimal anticoagulation treatment strategy in women in their reproductive years with mechanical valve thrombosis is discussed. (Neth Heart J 2007;15:306-9).

Warfarin embryopathy: fetal manifestations

During the period 1991-2007, autopsy was undertaken in 13 fetuses with warfarin embryopathy. Pregnancy data and radiographic babygrams were available in each instance. Gestational age ranged from 17 to 37 weeks. Eleven of the fetuses had the characteristic nasal hypoplasia, but only three had radiological epiphyseal stippling. Cerebral hemorrhage was a major feature of autopsy in 8 of the fetuses, and it is evident that bleeding is a significant factor in the pathogenesis of warfarin embryopathy. A wide variety of additional visceral manifestations which were observed at autopsy have been tabulated. There was no obvious correlation between maternal or gestational age and the presence and severity of any specific embryopathic feature. No information was available concerning the dose and timing of warfarin administration in this series.

Pregnancy follow-up in a patient with mechanical valve: possible in sub-Saharan Africa?

BACKGROUND

In Africa in general and in Cameroon in particular, post rheumatic cardiopathies are a health care problem, one of the causes of infertility in the women population and a major cause of death among children and adults. Management of a pregnant woman with mechanical heart valve is a complex issue for all health care providers involved in the care of such patients.

PATIENT AND CASE REPORT

Miss A is 26-years old and consulted for cardiac assessment; referred from Bamenda (North-West province of Cameroon) for better management of a cardiac problem including arrhythmia and a history of recurrent tonsillitis. The cardiac echo-dopplerography showed severe post-rheumatic mitral valve regurgitation with pulmonary hypertension and a dysfunctional left ventricle. The patient was later evacuated in a surgical centre in Milan San Donato (Italy) where a St. Jude mechanical heart valve N.27 was implanted. Two years after surgery, during a follow-up visit, the patient brought a pelvic ultrasound showing a single live intrauterine foetus, gestational age estimated at 7 weeks.

CONCLUSION

Management of mechanical valve in a pregnancy context, resulting in a favourable outcome (no thromboembolic events and the delivery of a healthy baby) is possible in sub-Saharan Africa. Close observation, adherence to existing clinical guidelines, patient cooperation and an appropriate technical infrastructure are critical factors to consider.