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Patient-prosthesis mismatch in pregnancy.
Robert C Johnston1, Morgan L Swank, Vineet K Shrivastava
1Department of Obstetrics & Gynecology, University of California Irvine Medical Center, Orange, and Miller Children's Hospital-Long Beach Memorial Medical Center, Long Beach, California.
Obstetrics and Gynecology
|January 14, 2014
Summary
Severe patient-prosthesis mismatch after aortic valve replacement in pregnancy is rare and carries significant risks. This case highlights the potential for fetal demise following complex cardiac surgery during gestation.
Area of Science:
- Cardiovascular Surgery
- Maternal-Fetal Medicine
- Prosthetic Valve Management
Background:
- Patient-prosthesis mismatch (PPM) is a recognized complication of aortic valve repair.
- Literature on PPM in pregnant patients is scarce.
- Prosthetic heart valves in pregnancy require careful management.
Observation:
- A pregnant woman developed severe PPM post-aortic valve replacement.
- She underwent aortic valve replacement with aortic root enlargement and a larger valve at 21 weeks gestation.
- Postoperative fetal death occurred.
Findings:
- Cardiopulmonary bypass and aortic valve replacement pose substantial risks to both mother and fetus.
- Severe PPM can complicate pregnancy after aortic valve surgery.
- Fetal outcomes may be adversely affected by maternal cardiac interventions.
Implications:
- Obstetricians must be vigilant for PPM in pregnant patients with prosthetic valves.
- Management strategies for pregnant women with prosthetic valves need to consider PPM risks.
- This case underscores the critical need for multidisciplinary care in managing complex cardiac conditions during pregnancy.
