Maternal, fetal outcome, and anticoagulant management in pregnant women with prosthetic heart valves

Abstract

Introduction: Cardiac disease in maternity is a great problem particularly in developing countries. Pregnant patients with prosthetic heart valves (PHV) may suffer therapeutic difficulty, as the need for anticoagulation is fraught with risk of hemorrhagic or thromboembolic complications and structural valve deterioration. The present study aimed to evaluate the maternal, fetal outcome, and anticoagulant management in pregnant women with PHV. Materials and Methods: This study is prospective observational research. The medical archives of pregnant patients with PHV from September 2010 to January 2015 were scanned. Data collected from Yuzuncu Yil University Hospital Cardiology clinics archives included demographic characteristics, anticoagulant, presence or absence of obstructive or non-obstructive thrombus, and maternal-fetal outcome. Results: The authors evaluated the outcomes of 56 pregnant patients with PHV. The age at the time of pregnancy ranged between 19 and 37 (mean 28.7 +/- 8.4) years. Most common preferred anticoagulation therapy was heparin during the first trimester, followed by oral anticoagulation up to the 36th week, with subsequent replacement by heparin until delivery. Most common encountered complication was preterm birth. Death occurred in one patient due to obstructive valve thrombosis. Conclusion: Ideal PHV is not accessible for women during childbearing age. The risk of adverse event during pregnancy depends on valve position, symptoms, valve type, cardiac function, and functional capacity in patients with PHV. The active collaboration among an obstetrician, a cardiologist, and a cardiothoracic surgeon is required for optimal outcome patient with PHV.