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Int J Obstet Anesth. 2016 May;26:75-8. doi: 10.1016/j.ijoa.2015.11.008. Epub 2015 Dec 10.

Early postpartum mitral valve thrombosis requiring extra corporeal membrane oxygenation before successful valve replacement.

Author information

1
Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Sweden; Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. Electronic address: halla.halldorsdottir@karolinska.se.
2
Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Sweden.
3
Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Sweden; Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
4
Department of Obstetrics and Gynecology, Karolinska University Hospital Solna, Sweden.
5
Department of Cardiothoracic Surgery, Karolinska University Hospital Solna, Sweden.
6
Department of Cardiology, Karolinska University Hospital Solna, Sweden.

Abstract

Pregnancy is associated with an increased risk of thrombosis in women with mechanical prosthetic heart valves. We present the case of a 29-year-old woman who developed early postpartum mitral valve thrombus after an elective cesarean delivery. The patient had a mechanical mitral valve and was treated with warfarin in the second trimester, which was replaced with high-dose dalteparin during late pregnancy. Elective cesarean delivery was performed under general anesthesia at 37weeks of gestation. The patient was admitted to the intensive care unit for postoperative care and within 30min she developed dyspnea and hypoxia requiring mechanical ventilation. She deteriorated rapidly and developed pulmonary edema, worsening hypoxia and severe acidosis. Urgent extra corporeal membrane oxygenation was initiated. Transesophageal echocardiography revealed a mitral valve thrombus. The patient underwent a successful mitral valve replacement after three days on extra corporeal membrane oxygenation. This case highlights the importance of multidisciplinary care and frequent monitoring of anticoagulation during care of pregnant women with prosthetic heart valves.

KEYWORDS:

Cesarean section; Extra corporeal membrane oxygenation; Mitral valve replacement; Mitral valve thrombus

PMID:
26775895
DOI:
10.1016/j.ijoa.2015.11.008
[Indexed for MEDLINE]

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