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Related Experiment Videos

Pregnancy after mechanical mitral valve replacement.

Kerem M Vural1, M Ali Ozatik, Hasan Uncu

  • 1Department of Cardiovascular Surgery, Yüksek Ihtisas Hospital of Turkey, Ankara, Turkey.

The Journal of Heart Valve Disease
|June 14, 2003
PubMed
Summary

Pregnancy after mechanical mitral valve replacement (MVR) with low-dose warfarin and aspirin showed no congenital malformations or maternal complications. However, stopping anticoagulation postpartum increased prosthetic valve thrombosis risk.

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Area of Science:

  • Cardiovascular Surgery
  • Obstetrics and Gynecology
  • Pharmacology

Background:

  • Mitral valve replacement (MVR) in women of fertile age necessitates careful management during pregnancy.
  • Understanding prosthetic valve complications and pregnancy outcomes under various anticoagulation regimens is crucial.

Purpose of the Study:

  • To review prosthetic valve-related complications and pregnancy outcomes in patients with mechanical mitral valves.
  • To evaluate feto-maternal mortality and morbidity associated with different anticoagulation strategies during pregnancy.

Main Methods:

  • Retrospective review of 46 pregnancies in 32 patients who underwent MVR with a St. Jude Medical mechanical prosthesis.
  • Analysis of patient follow-up data (155 patient-years) focusing on anticoagulation regimens and pregnancy outcomes.

Related Experiment Videos

  • Kaplan-Meier survival estimates and rates of valve-related events were calculated.

    • Main Results:

    • Ten-year survival was 94%, with a 33% freedom from valve-related events.
    • Uninterrupted low-dose warfarin plus aspirin during pregnancy resulted in no congenital malformations or maternal mortality/morbidity in 20 live births.
    • Anticoagulation cessation, particularly postpartum, was linked to a high rate of prosthetic valve thrombosis.

    Conclusions:

    • Low-dose anticoagulation (warfarin plus aspirin) appears safe during pregnancy after MVR, avoiding major feto-maternal complications.
    • Discontinuation of anticoagulation, especially postpartum, significantly increases the risk of prosthetic valve thrombosis.
    • New-generation mechanical valves, despite low thrombogenicity, do not eliminate the risk of thrombosis upon anticoagulation cessation.