Obstetrics and Gynecology
doi: 10.25005/2074-0581-2023-25-3-441-447
EMERGENCY CESAREAN SECTION WITH REDO MITRAL VALVE REPLACEMENT FOR ACUTE PROSTHETIC VALVE DYSFUNCTION: A CASE REPORT

I. Kholod1, E. Buhman1, S. Grisaru-Granovsky2, T. Avitan2, S. Tager3, A. Nir4, A. Tvito5, Y. Gozal1, A. Ioscovich1

1Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel
2Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel
3Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel
4Department of Cardiology, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel
5Department of Hematology, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel

Objective: Cardiovascular diseases emerge as one of the leading causes of maternal morbidity and mortality in developed countries. These risks are even higher in women with prosthetic cardiac valves. The core of the care for these women and the fetus during the hypercoagulable state of the pregnancy and postpartum period is the achievement of coagulation control using adjusted anticoagulation therapy protocols. A multidisciplinary team that includes obstetricians, cardiologists, hematologists, and anesthesiologists in a referral center is essential for an optimal maternal-fetal outcome. In particular, these measures are directed at preventing one of the most serious complications associated with mechanical valve dysfunction. The dysfunctional valve in the mitral position increases maternal and fetal mortality by 30%, especially in the presence of heart failure symptoms. Here we present a case of a 32-week pregnant woman diagnosed with dysfunction of the mechanical mitral valve (MV) and an emergency multidisciplinary approach to her treatment.

Keywords: Pregnancy, cesarean delivery, anesthetic management, mechanical valve, valve dysfunction, valve replacement.

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References
  1. Roos-Hesselink J, Baris L, Johnson M, De Backer J, Otto C, Marelli A, et al. Pregnancy outcomes in women with cardiovascular disease: Evolving trends over 10 years in the ESC Registry of Pregnancy and Cardiac disease (RO-PAC). Eur Heart J. 2019;40:3848-55. https://doi.org/10.1093/eurheartj/ehz136
  2. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-241. https://doi.org/10.1093/eurheartj/ehy340
  3. Reimold SC, Rutherford JD. Clinical practice. Valvular heart disease in pregnancy. N Engl J Med. 2003;349(1):52-9. https://doi.org/10.1056/NEJMcp021265
  4. Cunha CR, Santos PC, Castineira CP, Pereira FSF. Heart valve replacement during pregnancy. Rev Bras Cir Cardiovasc. 2007;22(4):498-500. https://doi. org/10.1590/s0102-76382007000400019
  5. Danik S, Fuster V. Anticoagulation in pregnant women with prosthetic heart valves. Mt Sinai J Med. 2004;71:322-9.
  6. Butchart EG, Gohlke-Bärwolf C, Antunes MJ, Tornos P, De Caterina R, Cormier B, et al; Working groups on valvular heart disease, thrombosis, and cardiac rehabilitation and exercise physiology, European Society of Cardiology. Recommendations for the management of patients after heart valve surgery. Eur Heart J. 2005;26:2463-71. https://doi.org/10.1093/eurheartj/ehi426
  7. Anbarasan C, Kumar VS, Latchumanadhas K, Mullasari AS. Successful thrombolysis of prosthetic mitral valve thrombosis in early pregnancy. J Heart Valve Dis. 2001;10:393-5.
  8. Scirica BM, O’Gara PT. Valvular heart disease in pregnancy. Curr Cardiol Rep. 2006;8(2):83-9. https://doi.org/10.1007/s11886-006-0017-y
  9. Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: A systematic review of the literature. Arch Intern Med. 2000;160(2):191-6. https://doi.org/10.1001/archinte.160.2.191
  10. Hameed AB, Mehra A, Rahimtoola S. The role of catheter balloon commissurotomy for severe mitral stenosis in pregnancy. Obstet Gynecol. 2009;114:1336-40. https://doi.org/10.1097/AOG.0b013e3181bea92
  11. Kikon M, Dutta Choudhury K, Prakash N, Gupta A, Grover V, Kumar Gupta V. Mitral valve replacement in a young pregnant woman: A case report and review of literature. Res Cardiovasc Med. 2014;3(2):e17561. https://doi.org/10.5812/ cardiovascmed.17561
  12. Tzankis G, Morse DS. Cesarean section and reoperative aortic valve replacement in a 38-week parturient. J Cardiothorac Vasc Anesth. 1996;10(4):516-8. https:// doi.org/10.1016/s1053-0770(05)80016-3
  13. Sharma JB, Nigam M, Tempe A, Tempe DK, Gupta S. Cesarean section and reoperative mitral valve replacement for thrombosis of a mechanical valve in a 32-week parturient. Acta Obstet Gynecol Scand. 2003;82(1):89-90. https://doi. org/10.1034/j.1600-0412.2003.820116.x
  14. Lin TY, Chiu KM, Shieh JS, Chu SH. Emergency redo mitral valve replacement in a pregnant woman at third trimester: Case report and literature review. Circ J. 2008;72(10):1715-7. https://doi.org/10.1253/circj.cj-07-0775
  15. Shah AM, Ikram S, Kulatilake EN, Pearson JF, Hall RJ. Emergency mitral valve replacement immediately following caesarean section. Eur Heart J. 1992;13(6):847-9. https://doi.org/10.1093/oxfordjournals.eurheartj.a060268

Authors' information:

Kholod Ilia, MD,
Resident of Anesthesiology Program, Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with Hebrew University
Researcher ID: IWD-8768-2023
ORCID ID: 0009-0005-3397-1115
E-mail: holodis108@gmail.com

Buchmal Emmanuel, MD,
Senior Doctor, Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with Hebrew University
ORCID ID: 0009-0009-6373-3862
E-mail: buhmandoc@szmc.org.il

Grisaru-Granovsky Sorina,
Professor, Head of the Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 6602935452
ORCID ID: 0000-0003-3651-5156
E-mail: sorina@szmc.org.il

Avitan Tahila, MD,
Senior Doctor, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 56604228200
ORCID ID: 0000-0003-4402-0882
E-mail: avitan@szmc.org.il

Tager Salis, MD,
Head of the Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 6701354823
ORCID ID: 0009-0006-3520-6019
E-mail: salist@szmc.org.il

Nir Amiran,
Professor, Head of Pediatric Cardiology Unit, Department of Cardiology, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 7005974960
ORCID ID: 0000-0001-8195-0523
E-mail: nira@szmc.org.il

Tvito Ariella, MD,
Senior Doctor, Department of Hematology, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 55537589100
ORCID ID: 0000-0002-9371-6715
E-mail: ariellat@szmc.org.il

Gozal Yaacov,
Clinical Associate Professor, Head of Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 34769823800
ORCID ID: 0000-0002-9451-818X
E-mail: gozaly@szmc.org.il

Ioscovich Alexander,
Clinical Associate Professor, Head of Obstetric Anesthesiology Unit, Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 57207802045
ORCID ID: 0000-0001-6449-0254
E-mail: aioscovich@gmail.com

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Kholod Ilia, MD
Resident of Anesthesiology Program, Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with Hebrew University

9103102, Israel, Jerusalem, Shmuel Bait str., 12, 3rd floor

Tel.: +972 (54) 2309099

E-mail: holodis108@gmail.com

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