Managing Pregnancy with Post Mitral Valve Replacement Presenting Late

With the increased awareness and emphasis of institutional delivery, there has been an increase in trend of cases of valvular heart disease with pregnancy being reported to tertiary centers. Though rare, cases like post mitral valve replacement (MVR) with pregnancy are often a challenge in terms of management with an outcome of uneventful pregnancy and healthy baby. The management of women with prosthetic heart valves during pregnancy poses a particular challenge as there are no available controlled clinical trials to provide guidelines for effective antithrombotic therapy. Here we present a case of post MVR with pregnancy with an ultimate outcome of a healthy female and uneventful vaginal delivery. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 50-52 DOI: http://dx.doi.org/10.3126/njog.v8i1.8866

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Six-Year Experience with CarboMedics Prosthetic Heart Valves

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239600400306 ◽

1996 ◽

Vol 4 (3) ◽

pp. 152-156 ◽

Cited By ~ 1

Author(s):

Zhu Ping ◽

Long Guo Cui ◽

Li Zhong Xue ◽

Feng Shu Sheng ◽

Meng Hua ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Valves ◽

Prosthetic Heart Valve ◽

Functional Class ◽

Prosthetic Heart Valves ◽

Class Iii ◽

Mechanical Prosthesis ◽

Actuarial Survival

Between July 1989 and July 1995, 89 CarboMedics prosthetic heart valves were implanted in 70 patients (38 males, 32 females) ranging in age from 13 to 54 years (mean 33 years). Forty-one of these patients underwent mitral valve replacement, 10 had aortic valve replacement, and 19 had double aortic and mitral valve replacement. Early mortality was 4.9%, 0%, and 15.8% respectively in these groups. Mean follow-up time was 3.4 years and was 95.4% complete (3 lost). There were 5 late deaths (7.7%); 1 in the mitral group, 1 in the aortic group, and 3 who had double valve replacements. Three of these late deaths were considered valve-related. The 5-year actuarial survival rates, hospital mortality excluded, were 97% for mitral, 88% for aortic, and 88% for double valve replacement. Preoperatively, 80% of the patients were in New York Heart Association functional class III or IV, whereas postoperatively, 99.5% of the patients were in class I or II. No structural failures were observed. There was 1 case of systemic embolism and 1 case of valve thrombosis, neither of these patients were taking anticoagulants. Hemorrhage was the most frequent complication; 1 of 4 events was fatal. A less intensive warfarin regimen and improvement in hepatic function may reduce hemorrhagic risk while maintaining thromboembolic protection. On the basis of this experience, the CarboMedics prosthetic heart valve appears to be an excellent mechanical prosthesis for cardiac valve replacement, in terms of hemodynamic performance and low thrombogenicity, in patients receiving anticoagulants.

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Performance by Age Groups in Biological and Mechanical Cardiac Valve Replacement

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239700500302 ◽

1997 ◽

Vol 5 (3) ◽

pp. 130-136 ◽

Cited By ~ 1

Author(s):

Guy J Fradet ◽

WR Eric Jamieson ◽

Robert T Miyagishima ◽

A Ian Munro

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Valves ◽

Age Groups ◽

Age Group ◽

Biological Prosthesis ◽

Mechanical Prostheses ◽

Valve Prostheses ◽

Biological Prostheses

A group of 1195 patients who received biological valve prostheses (mean age 57.3 years, range 8 to 85 years) and a group of 1345 patients who received mechanical heart valves (mean age 56.1 years, range 13 to 91 years) were analyzed for complications by age group (less than or equal to 54 years, 55 to 65 years, and over 65 years). The freedom from thromboembolism and anticoagulant-related hemorrhage at 8 years after aortic valve replacement was significantly higher in patients who received a biological prosthesis in all age groups. The freedom from thromboembolism and anticoagulant-related hemorrhage at 8 years after mitral valve replacement was significantly higher in patients who received a biological prosthesis in the age groups less than or equal to 54 years and over 65 years. The freedom from all valve-related complications at 5 and 8 years after aortic or mitral valve replacement showed the same trend of greater freedom from complications in biological prostheses patients compared with mechanical prostheses in most age groups. However, freedom from valve-related reoperation, mortality, and residual morbidity for aortic and mitral valve replacement for all age groups was not significantly different. These results show that biological prostheses can be considered for patients aged 55 years and older. The prostheses by age group or position at 8 years were not differentiated by valve-related reoperation, mortality, and residual morbidity. t 8 years there is a demonstrated price to pay for a presumed increase in longevity for patients with mechanical valves in the aortic position, reflected by an increase in thromboembolism and anticoagulant-related hemorrhage in all age groups.

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Transseptal Transcatheter Mitral Valve Replacement Using Balloon-Expandable Transcatheter Heart Valves

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2017.06.069 ◽

2017 ◽

Vol 10 (19) ◽

pp. 1905-1919 ◽

Cited By ~ 29

Author(s):

Marina Urena ◽

Dominique Himbert ◽

Eric Brochet ◽

Jose Luis Carrasco ◽

Bernard Iung ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Valves ◽

Transcatheter Mitral Valve Replacement

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Antithrombotic Treatment after Transcatheter Heart Valves Implant

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0037-1607457 ◽

2018 ◽

Vol 44 (01) ◽

pp. 038-045 ◽

Cited By ~ 15

Author(s):

Sabato Sorrentino ◽

Gennaro Giustino ◽

Kamilia Moalem ◽

Ciro Indolfi ◽

Roxana Mehran ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Valves ◽

Severe Aortic Stenosis ◽

Feasibility Studies ◽

Standard Of Care ◽

Bleeding Events ◽

Transcatheter Heart Valve ◽

Transcatheter Mitral Valve Replacement

AbstractTranscatheter heart valve replacement technology was introduced as alternative to surgery for the growing high-risk profile population. Developed first, aortic valve replacement (TAVR) became a standard of care for patients with severe aortic stenosis at high operative risk, with a potential future use also for low-risk subjects. In the last decade, a multitude of transcatheter mitral valve replacement (TMVR) devices have been developed for the treatment of severe mitral regurgitation, with encouraging results coming from first-in-man and feasibility studies. As for biological surgical-type valves, transcatheter implanted valves still preserve the risk of thrombosis and embolic events and anticoagulation- or antiplatelet-based strategies are the most widely used options. Unfortunately, these last remain recommended on the basis of empirical or not widely validated evidence. Therefore, given the exponential rise of TAVR and TMVR procedures, it is important to identify the optimal antithrombotic strategies that best fit the risk of thromboembolic and bleeding events. Hereafter, this review evaluates the current guidelines, trials, and observational data discussing antithrombotic strategy after transcatheter aortic or mitral valve replacement.

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Transcatheter Mitral Valve Replacement for Mitral Valve-in-Valve, Valve-in-Ring, and Valve-in-MAC Using Balloon-Expandable Transcatheter Heart Valves

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2021.02.034 ◽

2021 ◽

Vol 14 (8) ◽

pp. 873-878

Author(s):

Alessandro Sticchi ◽

David Reineke ◽

Fabien Praz ◽

Stephan Windecker

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Valves ◽

Transcatheter Mitral Valve Replacement ◽

Valve In Valve

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Acute Coronary Syndrome of Embolic Origin in a Patient on Direct Thrombin Inhibitor Three Years After Mechanical Mitral Valve Replacement

International Cardiovascular Forum Journal ◽

10.17987/icfj.v8i0.295 ◽

2016 ◽

Vol 8 ◽

Author(s):

Andrew Kei-yan Ng ◽

Man Hong Jim

Keyword(s):

Acute Coronary Syndrome ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Valves ◽

Alternative Explanation ◽

Direct Thrombin Inhibitor ◽

Thrombin Inhibitor ◽

Coronary Syndrome ◽

Post Operative Period

<p>Dabigatran was shown to be inferior to warfarin for patients with mechanical heart valves. However it was postulated that its inferiority was limited to early post-operative period where the valves had not been adequately endothelialized. We present a case where thromboembolic acute coronary syndrome developed in a patient six months after switching from warfarin to dabigatran, despite three years after mechanical mitral valve replacement. We propose an alternative explanation for dabigatran failure. </p>

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