The clinical characteristics and pregnancy outcomes analysis of pregnant women after mitral valve replacement with mechanical prosthetic valves

Niu Baorong; Gu Xiaoyan; Wang Yueli; Yang Xu; He Yihua

doi:10.3760/j.issn.1673-4777.2024.11.020

Abstract：Objective To analyse the clinical characteristics and pregnancy outcomes of pregnant women after mitral valve replacement with mechanical prosthetic valves,in order to provide evidence for the safe diagnosis and treatment of this population.Methods The clinical data of 49 pregnant women after mechanical mitral valve replacement admitted to Beijing Anzhen Hospital,Capital Medical University from January 2013 to January 2023 were retrospectively analyzed.The maternal age,gestational age,valve replacement time,neonatal weight,inter-national normalized ratio,delivery mode and echocardiography differences were retrospectively analyzed,and the clinical data characteristics and pregnancy outcomes of the patients were summarized.Results Forty-nine pregnant women were aged(31±4)years,gestational week(26±14)weeks,gestational time to valve replacement(8±5)years,hemoglobin(115±10)g/L,glutamate transaminase(13±8)U/L,blood creatinine(45±7)μmol/L,international standardized ratio 1.8±0.6,mitral mechanical valve orifice area(2.4±0.6)cm2,mitral mechanical valve orifice velocity(197±49)cm/s,left ventricular end diastolic diameter(47±5)mm,and left ventricular ejection fraction(61±6)％.Among them,5 cases were found to have valve dysfunction,of which 3 cases had mechanical valve blockage during mid pregnancy(28 weeks in case 1,30 weeks in case 2 and 19 weeks in case 5).Case 1 suffered fetal death at 28 weeks and underwent valve replacement.Case 2 was treated with conservative dual antiplatelet therapy and delivered by cesarean section at 34 weeks of gestation with normal birth.In case 5,valve replacement was performed to protect the fetus,and the fetus was delivered by cesarean section at 37 weeks of gestation.Conclusion A reasonable anticoagulation strategy should be developed for pregnant women after mechanical valve replacement.Due to changes in physiological conditions during pregnancy,the anticoagulation regimen needs to be continuously adjusted.During the whole pregnancy,blood pressure,heart rate and various anticoagulation indicators should be closely monitored,and echocardiography should be performed regularly.At the same time,a multidisciplinary comprehensive evaluation method should be taken to ensure the safety of pregnancy and provide reliable diagnosis and treatment basis for pregnant women to ensure the safety of mother and child.