Galván-Román LL, García-Hernández E, Verdín-Vázquez R, Ferra-Ferrer R, Enciso-Gómez R, Lara-Olivarez A, Camacho-Morales R

Language: Spanish
References: 22
Page: 138-143
PDF size: 279.07 Kb.

ABSTRACT

The pregnant woman with cardiac prosthesis valves, and especially if they have mechanics prosthesis, have a number of complications including medical and ethical problems. We present a case report of a 21 years old patient with a history of cardiac rheumatic, six years ago she had a cardiac surgery with a change for a two hemidiscs mitral prosthesis, after of the surgery she presented heart block with an implantation of peace maker VVIR. In this time she is hospitalized with a 32 weeks of pregnancy with out any kind of anticoagulation. The echocardiography and fluoroscopy were performed, resulting in a prosthesis dysfunction of both discs. We decide to perform two procedures in the same surgical time; the cesarean type Kerr followed by prosthesis mitral change. We found the prosthesis of both hemidiscs with thrombus. The postoperative evolution was satisfactory. Actually the mother and the baby are stable and without complications. Conclusions: All the patients with a mechanical cardiac prosthesis and pregnancy require a perfect control with multiple specialties to offer a better management and treatment. This could provide a better survival to the mothers and the products.

REFERENCES

1. Siu SC, Sermer M, Colman JM et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001; 104:515.

2. Boer K, Cate JW, Sturk A, Borm JJ, Treffers PE. Enhanced thrombin generation in normal and hypertensive pregnancy. Am J Obstet Gynecol 1989; 160: 95-100.

3. Bonow RM, Carabello B, De Leon AC, Edmunds LH Jr, Fedderly BJ, Freed MD y cols. ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. JACC 2006; 48: e1–148.

4. North R, Sadler L, Stewart A et al. Long term survival and valve related complications in young women with cardiac valve replacements. Circulation 1999; 99: 2669. J Am Coll Cardiol 1998; 32: 1486-1488.

5. Vitali E, Donatelli F, Quaini E, Groppelli G, Pellegrini A. Pregnancy in patients with mechanical prosthetic heart valves. J Cardiovasc Surg 1986; 27: 221-227.

6. Meschengieser SS, Fondevila CG, Santarelli MT, Lazzari MA. Anticoagulation in pregnant women with mechanical, heart valve prostheses. Heart 1999; 82: 23-26.

7. Ibarra-Pérez C. El uso de anticoagulantes en enfermas embarazadas en las que se han implantado prótesis valvulares cardiacas de Starr-Edwards. Gac Med Mex 1973; 106: 239-248.

8. Salazar E, Zajarías A, Gutiérrez N, Iturbe I. The problem of cardiac valve prostheses, anticoagulants and pregnancy. Circulation 1984; (Suppl 1): 1169-1177.

9. Ibarra-Pérez C, Argüero R, Cobos SJ. La clínica de prótesis valvulares cardiacas. Filosofía, método y resultados iniciales. Prensa Med Mex 1973; 38: 149.

10. Wahlers T, Laas J, Alken A, Borst HG. Repair of acute type A aortic dissection after cesarean section in the thirty-ninth week of pregnancy. J Thorac Cardiovasc Surg 1994; 107: 314-315.

11. Vitali E, Donatelli F, Quaini E, Groppelli G, Pellegrini A. Pregnancy in patients with mechanical prosthetic heart valves. J Cardiovasc Surg 1986; 27: 221-227.

12. Mahli A, Izdes S, Coskun D. Cardiac operations during pregnancy: review of factors influencing fetal outcome. Ann Thorac Surg 2000; 69: 1622-1666.

13. Kole SD, Jain SM, Walia A, Sharma M. Cardiopulmonary bypass in pregnancy. Ann Thorac Surg 1997; 63: 915.

14. Lee C, Wu C, Lin P et al. Pregnancy following cardiac prosthetic valve replacement. Obstet Gynecol 1994; 83: 353.

15. Born D, Martinez E, Almeida P et al. Pregnancy in patients with prosthetic heart valves: the effects of anticoagulation on mother, fetus and neonate. Am Heart J 1992; 124: 413.

16. Salazar E, Izaguirre R, Verdejo J et al. Failure of adjusted doses of subcutaneous heparin to prevent thromboembolic phenomena in pregnant patients with mechanical cardiac valve prostheses. J Am Coll Cardiol 1996; 27: 1698.

17. Ferrans V, Tomita Y, Hilbert S et al. Evaluation of operatively excised prosthetic tissue valves. In: Waller B, ed. Pathology of the heart an great vessels. New York: Churchill Livingstone, 1988: 311.

18. Hung L, Rahimtoola S. Prosthetic heart valves and pregnancy. Circulation 2003; 107: 1240.

19. Hirsh J, Fuster V. Guide to anticoagulant therapy, part 2: oral anticoagulants. American Heart Association. Circulation 1994; 89: 1469.

20. Oakley C. Pregnancy and prosthetic heart valves. Lancet 1994; 344: 1643.

21. Turpie A, Gent M, Laupacis A et al. Comparison of aspirin with placebo in patients treated with warfarin after heart valve replacement. N Engl J Med 1993; 329: 524.

22. Careaga G, Ramírez S, Ramírez A, Argüero R. Disfunción de prótesis mitral mecánica en embarazadas. Informe de dos casos. Gac Med Mex 1997; 133: 535-539.