Surgical treatments for woman with mechanical valve dysfunction during pregnancy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Yongbin , LU Cong , HUANG Jingsong , LIU Jing , GUO Huiming , ZHUANG Jian , HUANG Huanlei ,  CHEN Jimei

1. Guangdong Provincial Cardiovascular Institute, Guangzhou, 510080, P.R.China;
2. Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P.R.China;

Corresponding author：

CHEN Jimei, Email: jimei@hotmail.com

Keywords：

Mechanical valve; gestation; valve dysfunction; cesarean section

DOI：

10.7507/1007-4848.202005067

Video：

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Objective To explore the therapeutic effects of different surgical strategies on women with mechanical valve dysfunction during pregnancy.Methods A total of 11 patients with mechanical valve dysfunction during pregnancy who underwent surgeries in our hospital from 2007 to 2017 were retrospectively included. The average age was 27.5±3.7 years. The prognosis of patients was analyzed according to the gestational weeks, cardiac function and the severity of mechanical valve dysfunction.Results No death occurred. Three of them suffered subtotal hysterectomy during the surgery because of uncontrolled bleeding, and the others recovered without complications. Among the 5 patients with pregnancies <28 weeks, 1 patient was found intrauterine death before hospital admission, 2 suffered fetal loss 5 days after the cardiac surgery, and the other 2 patients continued their gestations until deliveries. Among the other 6 patients with pregnancies >28 weeks, 1 fetus died because of intracranial hemorrhage, and the other 5 survived without embryopathy or foetopathy.Conclusion Gestation week, cardiac function and severity of mechanical valve dysfunction may be taken into account when making a treatment regimen for women with dysfunctional valve prostheses during pregnancy.

Citation： CHEN Yongbin, LU Cong, HUANG Jingsong, LIU Jing, GUO Huiming, ZHUANG Jian, HUANG Huanlei, CHEN Jimei. Surgical treatments for woman with mechanical valve dysfunction during pregnancy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(8): 940-944. doi: 10.7507/1007-4848.202005067 Copy

1.	Elassy SM, Elmidany AA, Elbawab HY. Urgent cardiac surgery during pregnancy: A continuous challenge. Ann Thorac Surg, 2014, 97(5): 1624-1629.
2.	Zitnik RS, Brandenburg RO, Sheldon R, et al. Pregnancy and open-heart surgery. Circulation, 1969, 39(5 Suppl 1): I257-I262.
3.	Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J, 2018, 39(34): 3165-3241.
4.	Peverill RE. Warfarin or aspirin: Both or others? Med J Aust, 1999, 171(6): 321-326.
5.	Vitale N, De Feo M, De Santo LS, et al. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol, 1999, 33(6): 1637-1641.
6.	胡大一, 张鹤萍, 孙艺红, 等. 华法林与阿司匹林预防非瓣膜性心房颤动患者血栓栓塞的随机对照研究. 中华心血管病杂志, 2006, 34(4): 295-298.
7.	Choi JW, Pai SH. Tissue plasminogen activator levels change with plasma fibrinogen concentrations during pregnancy. Ann Hematol, 2002, 81(11): 611-615.
8.	Uchikova EH, Ledjev II. Changes in haemostasis during normal pregnancy. Eur J Obstet Gynecol Reprod Biol, 2005, 119(2): 185-188.
9.	Szecsi PB, Jørgensen M, Klajnbard A, et al. Haemostatic reference intervals in pregnancy. Thromb Haemost, 2010, 103(4): 718-727.
10.	Wickström K, Edelstam G, Löwbeer CH, et al. Reference intervals for plasma levels of fibronectin, von Willebrand factor, free protein S and antithrombin during third-trimester pregnancy. Scand J Clin Lab Invest, 2004, 64(1): 31-40.
11.	Bian C, Wei Q, Liu X. Influence of heart-valve replacement of warfarin anticoagulant therapy on perinatal outcomes. Arch Gynecol Obstet, 2012, 285(2): 347-351.
12.	Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2012, 141(2 Suppl): e691S-e736S.
13.	Xu Z, Fan J, Luo X, et al. Anticoagulation regimens during pregnancy in patients with mechanical heart valves: A systematic review and meta-analysis. Can J Cardiol, 2016, 32(10): 1248.e1-1248.e9.
14.	Abildgaard U, Sandset PM, Hammerstrøm J, et al. Management of pregnant women with mechanical heart valve prosthesis: Thromboprophylaxis with low molecular weight heparin. Thromb Res, 2009, 124(3): 262-267.
15.	European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM), et al. 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): 3147-3197.
16.	Leonhardt G, Gaul C, Nietsch HH, et al. Thrombolytic therapy in pregnancy. J Thromb Thrombolysis, 2006, 21(3): 271-276.
17.	National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med, 1995, 333(24): 1581-1587.
18.	Carnero-Alcázar M, Reguillo-Lacruz F, Montes-Villalobos L, et al. Mechanical prosthetic mitral valve thrombosis in a first trimester pregnant woman. Interact Cardiovasc Thorac Surg, 2010, 10(1): 116-118.
19.	Bernal JM, Miralles PJ. Cardiac surgery with cardiopulmonary bypass during pregnancy. Obstet Gynecol Surv, 1986, 41(1): 1-6.
20.	Becker RM. Intracardiac surgery in pregnant women. Ann Thorac Surg, 1983, 36(4): 453-458.
21.	Kapoor MC. Cardiopulmonary bypass in pregnancy. Ann Card Anaesth, 2014, 17(1): 33-39.
22.	Di Lorenzo G, Martucci G, Sciacca S, et al. Dysfunction of mechanical mitral prosthesis at 33rd week of pregnancy: ECMO support as a complex strategy for the mother and the fetus. Perfusion, 2016, 31(7): 611-613.

1. Elassy SM, Elmidany AA, Elbawab HY. Urgent cardiac surgery during pregnancy: A continuous challenge. Ann Thorac Surg, 2014, 97(5): 1624-1629.
2. Zitnik RS, Brandenburg RO, Sheldon R, et al. Pregnancy and open-heart surgery. Circulation, 1969, 39(5 Suppl 1): I257-I262.
3. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J, 2018, 39(34): 3165-3241.
4. Peverill RE. Warfarin or aspirin: Both or others? Med J Aust, 1999, 171(6): 321-326.
5. Vitale N, De Feo M, De Santo LS, et al. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol, 1999, 33(6): 1637-1641.
6. 胡大一, 张鹤萍, 孙艺红, 等. 华法林与阿司匹林预防非瓣膜性心房颤动患者血栓栓塞的随机对照研究. 中华心血管病杂志, 2006, 34(4): 295-298.
7. Choi JW, Pai SH. Tissue plasminogen activator levels change with plasma fibrinogen concentrations during pregnancy. Ann Hematol, 2002, 81(11): 611-615.
8. Uchikova EH, Ledjev II. Changes in haemostasis during normal pregnancy. Eur J Obstet Gynecol Reprod Biol, 2005, 119(2): 185-188.
9. Szecsi PB, Jørgensen M, Klajnbard A, et al. Haemostatic reference intervals in pregnancy. Thromb Haemost, 2010, 103(4): 718-727.
10. Wickström K, Edelstam G, Löwbeer CH, et al. Reference intervals for plasma levels of fibronectin, von Willebrand factor, free protein S and antithrombin during third-trimester pregnancy. Scand J Clin Lab Invest, 2004, 64(1): 31-40.
11. Bian C, Wei Q, Liu X. Influence of heart-valve replacement of warfarin anticoagulant therapy on perinatal outcomes. Arch Gynecol Obstet, 2012, 285(2): 347-351.
12. Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2012, 141(2 Suppl): e691S-e736S.
13. Xu Z, Fan J, Luo X, et al. Anticoagulation regimens during pregnancy in patients with mechanical heart valves: A systematic review and meta-analysis. Can J Cardiol, 2016, 32(10): 1248.e1-1248.e9.
14. Abildgaard U, Sandset PM, Hammerstrøm J, et al. Management of pregnant women with mechanical heart valve prosthesis: Thromboprophylaxis with low molecular weight heparin. Thromb Res, 2009, 124(3): 262-267.
15. European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM), et al. 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): 3147-3197.
16. Leonhardt G, Gaul C, Nietsch HH, et al. Thrombolytic therapy in pregnancy. J Thromb Thrombolysis, 2006, 21(3): 271-276.
17. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med, 1995, 333(24): 1581-1587.
18. Carnero-Alcázar M, Reguillo-Lacruz F, Montes-Villalobos L, et al. Mechanical prosthetic mitral valve thrombosis in a first trimester pregnant woman. Interact Cardiovasc Thorac Surg, 2010, 10(1): 116-118.
19. Bernal JM, Miralles PJ. Cardiac surgery with cardiopulmonary bypass during pregnancy. Obstet Gynecol Surv, 1986, 41(1): 1-6.
20. Becker RM. Intracardiac surgery in pregnant women. Ann Thorac Surg, 1983, 36(4): 453-458.
21. Kapoor MC. Cardiopulmonary bypass in pregnancy. Ann Card Anaesth, 2014, 17(1): 33-39.
22. Di Lorenzo G, Martucci G, Sciacca S, et al. Dysfunction of mechanical mitral prosthesis at 33rd week of pregnancy: ECMO support as a complex strategy for the mother and the fetus. Perfusion, 2016, 31(7): 611-613.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatments for woman with mechanical valve dysfunction during pregnancy

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