Abstract
A 21-year-old woman in the 16th week of pregnancy was admitted due to acute presentation of severe exertional dyspnea. She had undergone mitral valve replacement (MVR) with bioprosthetic valve for infective endocarditis 2 years ago. She developed congestive heart failure from mitral bioprosthetic valve stenosis due to early structural valve deterioration. She also had severe pulmonary hypertension and underwent a redo MVR using a mechanical valve prosthesis with good maternal outcome but fetal demise. This report brings up the debate about what type of valve should be used in women in reproductive age, and discusses the management of severe mitral stenosis and stenosis of a bioprosthetic valve during pregnancy. Surgical options can almost always be delayed until fetal maturity is achieved and a simultaneous cesarean section can be performed. However, under certain circumstances when the maternal welfare is in jeopardy the surgical intervention is mandatory even before the fetus reaches viability.
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References
Elkayam U, Bitar F. Valvular heart disease and pregnancy: part II: prosthetic valves. J Am Coll Cardiol. 2005;46(3):403–10.
Jamieson WRE, Miller DC, Akins CW, Munro AI, Glower DD, Moore KA, et al. Pregnancy and bioprosthesis: influence of structural valve deterioration. Ann Thorac Surg. 1995;60:S282–7.
Cleuziou J, Horer J, Kaemmerer H, Teodorowicz A, Kasnar-Samprec J, Schreiber C, et al. Pregnancy does not accelerate biological valve degeneration. Int J Cardiol. 2010;145:418–21.
Scirica BM, O’Gara PT. Valvular heart disease in pregnancy. Curr Cardiol Rep. 2006;8:83–9.
Chang WS, Anand S, Ginsberg JF. Antioagulation of pregnant women with mechanical valves. Arch Intern Med. 2000;160:191–6.
Reimold SC, Rutherford JD. Valvular heart disease in pregnancy. N Engl J Med. 2003;349:52–9.
ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Developed in Collaboration With the Society of Cardiovascular Anesthesiologists: Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006;114:450–527.
European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM), ESC Committee for Practice Guidelines. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147–97.
Norrad RS, Salehian O. Management of severe mitral stenosis during pregnancy. Circulation. 2011;124:2756–60.
Nobuyoshi M, Arita T, Shirai SI, Hamasaki N, Yokoi H, Iwabuchi M, et al. Percutaneous balloon mitral valvuloplasty. Circulation. 2009;119:e211–9.
Hamatani Y, Saito N, Tazaki J, Natsuaki M, Nakai K, Makiyama T, et al. Percutaneous balloon valvuloplasty for bioprosthetic mitral valve stenosis. Heart Vessels. 2012. doi 10.1007/s00380-012-0309-7. (Epub ahead of print).
Cunha CR, Santos PC, Castineira CP, Pereira FSF. Heart valve replacement during pregnancy. Rev Bras Cir Cardiovasc. 2007;22(4):498–500.
Hameed AB, Mehra A, Rahimtoola S. The role of catheter balloon commissurotomy for severe mitral stenosis in pregnancy. Obstet Gynecol. 2009;114:1336–40.
Lin TY, Ciu KM, Shieh JS, Chu SH. Emergency redo mitral valve replacement in a pregnant woman at third trimester. Cir J. 2008;72(10):1715-7.
Sepehripour AH, Lo TT, Shipolini AR, McCormack DJ. Can pregnant women be safely placed on cardiopulmonary bypass? Interact CardioVasc Thorac Surg. 2012;15:1063–71.
Acknowledgments
We would like to thank Dr. Yu Wendong for his collaboration in histopathological image annotation and Dr. Martin S. Bilsker for his support in echocardiographic imaging.
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11748_2013_366_MOESM1_ESM.avi
Three-dimensional echocardiography demonstrating thickening and restricted motion of structure deteriorated mitral bioprostheses from left atrial view (AVI 1338 kb)
11748_2013_366_MOESM2_ESM.avi
Three-dimensional echocardiography demonstrating thickening and restricted motion of structure deteriorated mitral bioprostheses from left ventricular view (AVI 1093 kb)
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Munoz-Mendoza, J., Pinto Miranda, V., Tanawuttiwat, T. et al. Severe bioprosthetic mitral valve stenosis in pregnancy. Gen Thorac Cardiovasc Surg 64, 38–42 (2016). https://doi.org/10.1007/s11748-013-0366-6
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DOI: https://doi.org/10.1007/s11748-013-0366-6