[Low molecular weight heparin in pregnancy. Report of three cases with pure mitral stenosis]

Three pregnant women with 5 +/- 1.7 weeks of pregnancy and mitral stenosis are described. Their valve area were < 1.0 cm2. They received medical treatment with little improvement and were included in our valvotomy percutaneous mitral (VPM) program with Inoue technique before their 30th week of pregnancy. Before they were treated with low molecular weight heparin (LMWH), Enoxiparin) as prophylaxis of intracavitary thrombus formation transthoracic and transesophageal echocardiogram demonstrated the absence of thrombus. We used 40 mgs. subcutaneous injection once a day during 16 weeks. Repeated transthoracic and transesophageal echocardiogram during VPM showed no evidence of intracavitary thrombus. Complete blood count and coagulation parameters remained within normal limits. The three cases delivered a healthy products. In conclusion, although this series is small, we show that the LMWH can be used in the first trimester of pregnancy as prophylactic treatment instead of oral anticoagulant treatment.