Prosthetic mitral valve thrombosis in a known case of rheumatic heart disease at 37 weeks pregnancy: a case report

Pregnancy with prosthetic valve is a challenging situation since this is a hypercoagulable state and maintenance of anticoagulation for prosthetic valves becomes difficult due to the teratogenic effects and altered pharmacokinetics of anticoagulant drugs. Despite adequate anticoagulation, the incidence of prosthetic valve thrombosis has been estimated as 4% to 14% during pregnancy. Management decisions for this life-threatening complication are complex. Open-heart surgery has a very high risk of maternal mortality and fetal loss, especially in early pregnancy. Furthermore, bleeding and embolic risks associated with thrombolytic agents, the limited efficacy of thrombolysis in certain subgroups, and a lack of experience in the setting of pregnancy raise important concerns. Mrs. X, a 36-year-old, gravida 3, para1+1 with 37 weeks pregnancy presented at Apollo hospitals, Ahmedabad in emergency department with complaints of severe dry cough and breathlessness for 24 hours. On through workup, she was diagnosed as mitral valve thrombosis in a known case of rheumatic heart disease post mitral valve replacement at 37 weeks pregnancy with late onset fetal growth restriction. After multi-speciality consultation she underwent thrombolytic therapy followed by high-risk emergency caesarean section. She delivered healthy male child, weight 2.21 kg and was discharged on 4th post-op day. Management of pregnant patients with mechanical valves is complex, especially when valve thrombosis and other complications occur. Multidisciplinary approach is essential and, in this case, led to successful maternal and foetal outcome.

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Optimising echocardiographic screening for rheumatic heart disease in New Zealand: not all valve disease is rheumatic

Cardiology in the Young ◽

10.1017/s1047951111000266 ◽

2011 ◽

Vol 21 (4) ◽

pp. 436-443 ◽

Cited By ~ 48

Author(s):

Rachel H. Webb ◽

Nigel J. Wilson ◽

Diana R. Lennon ◽

Elizabeth M. Wilson ◽

Ross W. Nicholson ◽

...

Keyword(s):

Heart Disease ◽

New Zealand ◽

High Risk ◽

Mitral Valve ◽

Rheumatic Heart Disease ◽

Secondary Prophylaxis ◽

Accurate Diagnosis ◽

High Risk Population ◽

Step Model ◽

Rheumatic Heart

AbstractAimsEchocardiography detects a greater prevalence of rheumatic heart disease than heart auscultation. Echocardiographic screening for rheumatic heart disease combined with secondary prophylaxis may potentially prevent severe rheumatic heart disease in high-risk populations. We aimed to determine the prevalence of rheumatic heart disease in children from an urban New Zealand population at high risk for acute rheumatic fever.Methods and resultsTo optimise accurate diagnosis of rheumatic heart disease, we utilised a two-step model. Portable echocardiography was conducted on 1142 predominantly Māori and Pacific children aged 10–13 years. Children with an abnormal screening echocardiogram underwent clinical assessment by a paediatric cardiologist together with hospital-based echocardiography. Rheumatic heart disease was then classified asdefinite, probable, orpossible. Portable echocardiography identified changes suggestive of rheumatic heart disease in 95 (8.3%) of 1142 children, which reduced to 59 (5.2%) after cardiology assessment. The prevalence ofdefiniteandprobablerheumatic heart disease was 26.0 of 1000, with 95% confidence intervals ranging from 12.6 to 39.4. Portable echocardiography overdiagnosed rheumatic heart disease with physiological valve regurgitation diagnosed in 28 children. A total of 30 children (2.6%) had non-rheumatic cardiac abnormalities, 11 of whom had minor congenital mitral valve anomalies.ConclusionsWe found high rates of undetected rheumatic heart disease in this high-risk population. Rheumatic heart disease screening has resource implications with cardiology evaluation required for accurate diagnosis. Echocardiographic screening for rheumatic heart disease may overdiagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.

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Giant Left Atrium in Triple Rheumatic Heart Disease

International Cardiovascular Forum Journal ◽

10.17987/icfj.v13i0.498 ◽

2018 ◽

Vol 13 ◽

Author(s):

Gëzim Berisha ◽

Edmond Haliti ◽

Gani Bajraktari

Keyword(s):

Pulmonary Hypertension ◽

Heart Disease ◽

Mitral Valve ◽

Left Atrium ◽

Rheumatic Heart Disease ◽

Heart Surgery ◽

Open Heart Surgery ◽

Heart Team ◽

Giant Left Atrium ◽

Rheumatic Heart

The giant left atrium (GLA) is a rare condition, commonly associated with rheumatic mitral valve disease, and very rarely with non rheumatic heart disease (nRHD). The triple valvular heart disease with involved mitral, aortic and tricuspid valves is quite uncommon. A 47 year female patient with a past medical history of rheumatic heart disease (RHD) and known severe mitral stenosis was with severe breathlessness (NYHA class IV). She had undergone mitral valve commissurotomy and tricuspid valve annuloplasty 12 years previously. Transthoracic echocardiography revealed a giant left atrium, moderate to severe mitral valve restenosis, severe mitral regurgitation, moderate aortic regurgitation and severe tricuspid regurgitation, associated with severe secondary pulmonary hypertension and a markedly dilated right heart chambers. The patient was considered inoperable by the heart team, because of advanced pulmonary hypertension predicting a very high risk for open heart surgery. The final treatment decision was a difficult and complex issue.

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