ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Clinical outcomes of pregnant women with mechanical heart valves
Aslıhan Küçüker1, Elif Gül Yapar Eyi2, Şeref Alp Küçüker1, Okan Yurdakök3, Mete Hıdıroğlu1, Zeki Çatav3, Ayşe Gül Kunt1, Mustafa Paç3, Erol Şener1
Atatürk Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara, Türkiye
1Atatürk Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara, Türkiye
2Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
3Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara, Türkiye
DOI : 10.5606/tgkdc.dergisi.2014.9335
Background: This study aims to investigate the pregnancy histories of women with mechanical heart valves and to establish a conclusion for an optimal management strategy for these patients.

Methods: Sixty-three female patients (mean age 36.8 years; range 22 to 48 years) who underwent mechanical heart valve prosthesis during the child-bearing age were included. Their gestational history following valve surgery was questioned. A total of 36 pregnancies in 24 patients were noted. Spontaneous or medical abortus, stillbirths, live births, embriopathies and mechanical valve thrombosis or any thromboembolic events were recorded. The pregnancy period and anticoagulation regimen used were thoroughly questioned in these patients.

Results: Clinical outcomes of a total of 36 pregnancies were as follows: 10 live births (9 healthy and 1 with warfarin embriopathy), 24 abortus in the first trimester (19 medical and 5 spontaneous) and two stillbirths. Three patients on low molecular weight heparin (LMWH) suffered from mechanical valve thrombosis and required emergency surgery. These patients survived but ended-up with medical abortus and stillbirth. Among the patients who had healthy births, four had LMWH throughout the pregnancy, five had LMWH in the first trimester, warfarin between 12 and 36 weeks followed by LMWH until delivery. Warfarin embriopathy occurred in one patient who received warfarin ≥5 mg during the first trimester.

Conclusion: This pilot study results demonstrate surprisingly high rates of gestation among patients with mechanical heart valve prosthesis bearing women. Termination of the pregnancy seems to be the most frequent approach to pregnant women with mechanical heart valve, although healthy births are also possible. For women wishing to continue their pregnancy, anticoagulation regimens and outcomes are diverse and inconclusive to suggest the superiority of one among others. However, this ongoing study aims to reach more precise and reliable information about medication by interviewing with more patients.

Keywords : Anticoagulation; mechanical heart valve; pregnancy
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