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Cardiac valve prostheses, anticoagulation, and pregnancy
The Annals of Thoracic Surgery
|April 1, 1977
Summary
For pregnant women with cardiac valve replacement, oral anticoagulants pose risks to both mother and fetus. Porcine heterografts are recommended to avoid anticoagulation, improving outcomes for cardiac surgery patients.
Area of Science:
- Cardiology
- Obstetrics
- Biomedical Engineering
Background:
- Cardiac valve replacement in women of childbearing age presents unique challenges regarding pregnancy.
- Management of anticoagulation during pregnancy after valve replacement is critical for maternal and fetal well-being.
Observation:
- A series of 7 pregnant women with cardiac valve replacement was studied.
- One infant died due to prematurity in a mother on oral anticoagulants; 6 infants survived.
- One mother died postpartum from a periprosthetic clot, despite receiving anticoagulation.
Findings:
- Oral anticoagulants cross the placental barrier, posing a risk to the fetus.
- Maternal risk of clotting complications is higher without anticoagulation compared to fetal risk with anticoagulation.
- The sole infant mortality was associated with maternal oral anticoagulant use until delivery.
Implications:
- Consideration of alternative prostheses, such as porcine heterografts, that do not require anticoagulation is crucial.
- Optimizing anticoagulation strategies or utilizing non-anticoagulant-requiring prostheses can improve pregnancy outcomes after cardiac valve replacement.
- Further research into the long-term safety and efficacy of different valve prostheses in pregnant patients is warranted.