Mechanical tricuspid valve thrombosis in pregnancy: a case report and literature review on anticoagulation challenges and fetal protection strategies.

IF 2.1 3区 医学 Q2 PEDIATRICS
Frontiers in Pediatrics Pub Date : 2025-07-02 eCollection Date: 2025-01-01 DOI:10.3389/fped.2025.1596199
San Zhu, Can Luo, Bing Luo, Yaoyao Zhang, Qiang Wei
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引用次数: 0

Abstract

Background: Pregnancy in women with mechanical heart valves (MHVs) poses significant challenges in balancing maternal thromboprophylaxis and fetal safety. Anticoagulation strategies must simultaneously prevent life-threatening valve thrombosis and minimize fetal risks, yet optimal management remains controversial. While warfarin offers effective thromboprophylaxis, its embryotoxicity at higher doses (>5 mg/day) contrasts with low molecular weight heparin (LMWH), which lacks consensus on thrombotic efficacy despite fetal safety advantages.

Case presentation: We report a case of a 30-year-old woman with mechanical mitral and tricuspid valves. She was maintained on low-dose warfarin (target INR 2.5-3.0) during early pregnancy. At 26-28 weeks of gestation, she developed exertional dyspnea; initial imaging showed stable valve function. At 33 + 2 weeks, worsening symptoms and echocardiographic evidence of tricuspid valve dysfunction prompted anticoagulation transition from warfarin to LMWH combined with vitamin K. After achieving an INR <1.4, cesarean delivery was performed at 33 + 3 weeks under general anesthesia, resulting in a live male infant without cardiac anomalies. Three days postpartum, mechanical tricuspid valve thrombosis with severe regurgitation was confirmed, necessitating bioprosthetic valve replacement on postoperative day 4. Maternal and neonatal outcomes were favorable.

Conclusions: This case highlights the importance of individualized anticoagulation management, multidisciplinary coordination, and vigilant monitoring in optimizing outcomes for pregnant patients with MHVs. Tailored pharmacologic strategies represent key modifiable prenatal factors influencing both maternal safety and child health.

妊娠期机械三尖瓣血栓形成一例报告及抗凝挑战和胎儿保护策略的文献回顾。
背景:有机械心脏瓣膜(MHVs)的妇女妊娠在平衡母体血栓预防和胎儿安全方面提出了重大挑战。抗凝策略必须同时预防危及生命的瓣膜血栓形成并将胎儿风险降至最低,但最佳管理仍然存在争议。虽然华法林提供了有效的血栓预防,但其高剂量(50毫克/天)的胚胎毒性与低分子量肝素(LMWH)形成对比,后者尽管具有胎儿安全优势,但在血栓疗效方面缺乏共识。病例介绍:我们报告一例30岁女性机械二尖瓣和三尖瓣。妊娠早期维持低剂量华法林(目标INR 2.5-3.0)。妊娠26-28周时,患者出现运动性呼吸困难;初步影像学显示瓣膜功能稳定。在33 + 2周时,三尖瓣功能障碍的症状恶化和超声心动图证据促使抗凝治疗从华法林转向低分子肝素联合维生素k。在达到INR后,结论:本病例强调了个体化抗凝治疗、多学科协调和警惕监测对优化mhv妊娠患者结局的重要性。量身定制的药物策略是影响孕产妇安全和儿童健康的关键可改变产前因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Frontiers in Pediatrics
Frontiers in Pediatrics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
3.60
自引率
7.70%
发文量
2132
审稿时长
14 weeks
期刊介绍: Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.
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