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Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Postpartum valve thrombosis: a happy ending thriller
Mario Bollati1, Claudio Moretti, Filippo Sciuto
1aDivision of Cardiology, University of Torino bEmergency Department, Division of Radiology, Molinette Hospital, Torino, Italy.
Journal of Cardiovascular Medicine (Hagerstown, Md.)
|December 16, 2010
Summary
A postpartum woman with mechanical heart valves experienced transient diplopia due to a thrombus causing aortic valve malfunction. Treatment involved anticoagulation, thrombolysis, and carotid filters, successfully resolving the thrombus and symptoms.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Obstetrics
Background:
- Mechanical heart valve prostheses require anticoagulation, typically with warfarin, to prevent thrombus formation.
- Pregnancy necessitates careful anticoagulation management, often involving a switch from warfarin to heparin-based agents like nadroparin.
Observation:
- A 29-year-old woman with two mechanical valve prostheses developed sudden, self-resolved diplopia postpartum.
- Echocardiography revealed severe aortic prosthesis regurgitation and a thrombus between the prostheses, causing intermittent valve malfunction.
- Subsequent echocardiography showed a thrombus adhering to the mitral prosthesis, fluctuating through the valve.
Findings:
- Intravenous heparin and tissue plasminogen activator infusion were administered for thrombus treatment.
- Placement of carotid filters during artery angioplasty successfully prevented cerebral embolization.
- Transesophageal echocardiography confirmed thrombus resolution, and the patient was discharged asymptomatic.
Implications:
- This case highlights the critical risk of thrombus formation and valve dysfunction in pregnant patients with mechanical heart valves, even with anticoagulation.
- Prompt and multi-modal treatment, including thrombolysis and embolic protection, can effectively manage complex prosthetic valve thrombosis.
- Careful anticoagulation strategies and vigilant monitoring are essential for pregnant women with mechanical heart valves to ensure maternal and fetal safety.
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