Valvular Heart Disease in Pregnancy

Bortnick, Anna E.; Levine, Lisa D.

doi:10.1097/grf.0000000000000570

Cited by 9 publications

(7 citation statements)

References 43 publications

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“…According to recent studies, the appropriate volume for a fluid challenge is either 250 mL bolus (crystalloid or colloid solutions) or 3 mL/kg of colloid solution at an infusion rate of 5-10 minutes [ 9 ]. Generally, the possibility of pulmonary edema in pregnant women with mitral valve stenosis is approximately 45%, as reported in the literature [ 10 ]. It is often the result of the decompression of the inferior vena cava combined with the autohemotransfusion (that happens due to uterine contractions), which leads to a preload increase.…”

Section: Discussionmentioning

confidence: 99%

“…), a full physical examination (murmurs, lower limbs edemas, etc. ), and a full electrocardiographic and TTE examination [ 10 ]. Medical history of former cardiac complications or pulmonary hypertension is typically followed by higher rates of complications.…”

Section: Discussionmentioning

confidence: 99%

“…The most frequently used β-blockers are cardioselective β1-blockers, such as metoprolol and bisoprolol. Atenolol should be avoided in pregnant women because it is responsible for delayed fetal development [ 10 ]. Restrictions on fluids and dietary salt are also recommended.…”

Section: Discussionmentioning

confidence: 99%

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The Use of Vigileo® Monitor in a Parturient With Severe Mitral Valve Stenosis and Severe Pulmonary Hypertension Undergoing Cesarean Section Under General Anesthesia: A Case Report and Literature Review

Griva¹,

Stamatakis²,

Varvarousi³

et al. 2022

Cureus

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We report a case of a 35-year-old pregnant female of Afghan origin who was admitted to the intensive care unit (ICU) because of pulmonary edema development when she was in the 30th week of gestation. During the bedside examination, the transthoracic echocardiogram (TTE) revealed severe mitral valve stenosis and pulmonary hypertension. The patient went into treatment with metoprolol for the control of tachycardia and furosemide for the prevention of fluid overload. During the 32nd week of gestation, the medical council decided on a cesarean section (CS) to be carried out under general anesthesia. The anesthesiologists decided to use the Vigileo monitor (Edwards Lifesciences, Irvine, CA, USA) as it is vitally important to approach fluid administration as fluid management is challenging concerning the obstetric patient. Vigileo monitoring is based on the invasive measurement of cardiac output (CO), cardiac index (CI), stroke volume (SV), and stroke volume variation (SVV). Fluid resuscitation based on hemodynamic parameters is a key component of patient care, especially in scenarios such as cardiovascular disease. This is the first case report where a Vigileo monitor was applied to a patient with severe mitral valve stenosis and severe pulmonary hypertension undergoing a cesarean section, which was accomplished without any complications. The patient was discharged from the hospital on the 12th postoperative day, hemodynamically stable.Each immigrant woman, regardless of her financial, social, cultural, or any other situation, has the fundamental right to receive complete perinatal healthcare. Nevertheless, the most recent statistical data show that those women's access to public healthcare is insufficient, leading to high rates of maternal mortality. The international medical community has to adapt to the new multicultural environment, and health services must be provided to this vulnerable population with the appropriate level of safety.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Use of Vigileo® Monitor in a Parturient With Severe Mitral Valve Stenosis and Severe Pulmonary Hypertension Undergoing Cesarean Section Under General Anesthesia: A Case Report and Literature Review

Griva¹,

Stamatakis²,

Varvarousi³

et al. 2022

Cureus

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“…[ 4 ] One-third of all cases of heart disease in pregnancy are valvular. [ 5 ] Mechanical heart valves (MHVs) can further increase the risk of thromboembolism, thus leading to the need for systemic anticoagulation; at present warfarin is the safest anticoagulant for use in pregnant females with MHVs. [ 6 , 7 ] However, warfarin is a small-molecular-weight compound that can easily cross the placenta [ 8 , 9 ] and may cause embryonic disease (nasal hypoplasia, stippled epiphyses, central nervous system, or ocular abnormalities) or fetal death.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation for mechanical heart valves during pregnancy: A case report and a literature review

Bai

Wenying

et al. 2022

Medicine

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Rationale: Most previous treatment guidelines for pregnant women with mechanical heart valves recommend that low molecular weight heparin (LMWH) should be applied once every 12 hours and only as required to reach peak anti-Xa levels of approximately 1.0 to 1.2 IU/mL, but it is commonly associated with subtherapeutic trough levels, consequently with an inadequate level of anticoagulation. Our case report here together with a literature review suggests that dose-adjusted (Target trough anti-Xa levels of 0.6 to 0.7 IU/mL and with peak anti-Xa levels of around 1.0 to 1.2 IU/mL or < 1.5 IU/mL) LMWH should be given thrice daily throughout pregnancy. In addition, the findings of this rare case indicate that a combination of LMWH and warfarin is effective in the treatment of small thromboses in pregnancy. Patient concerns: In the 1 st trimester of pregnancy, a 28-year old pregnant female with a mechanical valve had a significant increase in the aortic valve flow rate and suspected mechanical valve thrombosis. Diagnoses: The peak velocity of the pregnant female aortic mechanical valve increased, and mechanical valve thrombosis was suspected. Interventions: We adjusted the enoxaparin sodium dose every 12 hours to 1 injection every 8 hours, with a total daily dose of 160 mL. Based on the original application of LMWH, warfarin (3 mg/day) was recommended. Outcomes: The pregnant woman delivered a live baby by cesarean section, and the peak flow velocity of the mechanical valve in the aortic position was reduced to nearly equivalent to the patient’s pre-pregnancy status. The mother and the baby were in good health at the time of discharge. Lessons: LMWH is administered twice daily, and anti-Xa trough levels are mostly in a subtherapeutic state, which may lead to insufficient anticoagulation and thrombosis. Dose-adjusted LMWH thrice daily throughout pregnancy is the recommended treatment for pregnant women with mechanical heart valves. The combination of LMWH and warfarin exhibited good efficacy for the treatment of small thromboses.

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“…The concurrent incidence of venous stasis and hypercoagulability results in an almost 5-fold increase in the risk of venous thromboembolism during pregnancy [4]. One third of all cases of heart disease in pregnancy are valvular [5]. Mechanical heart valves (MHVs) can further increase the risk of thromboembolism, thus leading to the need for systemic anticoagulation; at present warfarin is the safest anticoagulant for use in pregnant females with MHVs [6,7].…”

Section: Introductionmentioning

confidence: 99%

The ultrasound outcomes of a pregnant female undergoing a double anticoagulant regimen due to suspected mechanical valve thrombosis: a case report and a literature review

Bai

Wenying

et al. 2022

Preprint

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Most previous treatment guidelines for pregnant women with mechanical heart valves (MHVs) recommended that low molecular weight heparin (LMWH) should be applied once every 12 hours and only as required to reach peak anti-Xa levels of around 1.0–1.2 IU/mL,but it is commonly associated with and subtherapeutic trough levels consequently with an inadequate level of anticoagulation. Our case report here together with a literature review suggests that dose-adjusted (Target trough anti-Xa levels of 0.6-0.7 IU/mL and with peak anti-Xa levels of around 1.0–1.2 IU/mL or less than 1.5 IU/mL) LMWH should be given thrice daily throughout pregnancy.In addition, the findings of this rare case indicate that a combination of LMWH and warfarin is effective in the treatment of small thromboses in pregnancy.

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Valvular Heart Disease in Pregnancy

Cited by 9 publications

References 43 publications

The Use of Vigileo® Monitor in a Parturient With Severe Mitral Valve Stenosis and Severe Pulmonary Hypertension Undergoing Cesarean Section Under General Anesthesia: A Case Report and Literature Review

The Use of Vigileo® Monitor in a Parturient With Severe Mitral Valve Stenosis and Severe Pulmonary Hypertension Undergoing Cesarean Section Under General Anesthesia: A Case Report and Literature Review

Anticoagulation for mechanical heart valves during pregnancy: A case report and a literature review

The ultrasound outcomes of a pregnant female undergoing a double anticoagulant regimen due to suspected mechanical valve thrombosis: a case report and a literature review

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