Redo aortic valve replacement in twin pregnancy: navigating high-risk cardiac surgery with maternal and fetal success - A case report

Redo aortic valve replacement (AVR) in pregnancy presents significant challenges due to maternal hemodynamics, fetal well-being, and anticoagulation management. Prosthetic valve stenosis is a life-threatening condition and can significantly alter the maternal and fetal outcome without treatment. We report a case of a pregnant woman with twin gestation who developed prosthetic valve stenosis due to pannus formation and requiring redo AVR.

A 31-year-old woman, pregnant with dichorionic diamniotic twins at 14 weeks, presented with worsening dyspnea. She had undergone mechanical AVR at 11 years of age and was on warfarin; however, she stopped taking warfarin since 2014. Echocardiography revealed prosthetic aortic valve stenosis, with severely elevated transvalvular gradients. She underwent redo AVR with a 21 mm On-X mechanical valve following aortic root enlargement. Postoperatively, she developed complete atrioventricular dissociation, requiring a permanent pacemaker. Multidisciplinary care ensured fetal viability, and she was discharged in stable condition with appropriate anticoagulation management.

Redo AVR during pregnancy requires meticulous planning, balancing maternal and fetal risks. This case highlights the complexities of anticoagulation strategies, surgical execution, and maternal-fetal monitoring.

A multidisciplinary approach is essential to optimize outcomes in pregnant patients undergoing redo AVR. Long-term follow-up is crucial for continued surveillance of prosthetic valve function and maternal health.