Mechanical tricuspid valve thrombosis in pregnancy: a case report and literature review on anticoagulation challenges and fetal protection strategies
BackgroundPregnancy 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 c...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1596199/full |
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| author | San Zhu San Zhu Can Luo Can Luo Bing Luo Bing Luo Yaoyao Zhang Yaoyao Zhang Qiang Wei Qiang Wei |
| author_facet | San Zhu San Zhu Can Luo Can Luo Bing Luo Bing Luo Yaoyao Zhang Yaoyao Zhang Qiang Wei Qiang Wei |
| author_sort | San Zhu |
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| description | BackgroundPregnancy 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 presentationWe 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.ConclusionsThis 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. |
| format | Article |
| id | doaj-art-2a8e4ac80a6e41c194d7137a82843cb0 |
| institution | Kabale University |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pediatrics |
| spelling | doaj-art-2a8e4ac80a6e41c194d7137a82843cb02025-08-20T03:29:09ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-07-011310.3389/fped.2025.15961991596199Mechanical tricuspid valve thrombosis in pregnancy: a case report and literature review on anticoagulation challenges and fetal protection strategiesSan Zhu0San Zhu1Can Luo2Can Luo3Bing Luo4Bing Luo5Yaoyao Zhang6Yaoyao Zhang7Qiang Wei8Qiang Wei9Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, ChinaKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, ChinaDepartment of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, ChinaKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, ChinaDepartment of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, ChinaKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, ChinaDepartment of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, ChinaKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, ChinaDepartment of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, ChinaKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, ChinaBackgroundPregnancy 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 presentationWe 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.ConclusionsThis 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.https://www.frontiersin.org/articles/10.3389/fped.2025.1596199/fullmechanical valve thrombosismaternal cardiac diseaseanticoagulation therapy in pregnancyfetal hemodynamic adaptationmultidisciplinary pregnancy careprenatal environmental factors |
| spellingShingle | San Zhu San Zhu Can Luo Can Luo Bing Luo Bing Luo Yaoyao Zhang Yaoyao Zhang Qiang Wei Qiang Wei Mechanical tricuspid valve thrombosis in pregnancy: a case report and literature review on anticoagulation challenges and fetal protection strategies Frontiers in Pediatrics mechanical valve thrombosis maternal cardiac disease anticoagulation therapy in pregnancy fetal hemodynamic adaptation multidisciplinary pregnancy care prenatal environmental factors |
| title | Mechanical tricuspid valve thrombosis in pregnancy: a case report and literature review on anticoagulation challenges and fetal protection strategies |
| title_full | Mechanical tricuspid valve thrombosis in pregnancy: a case report and literature review on anticoagulation challenges and fetal protection strategies |
| title_fullStr | Mechanical tricuspid valve thrombosis in pregnancy: a case report and literature review on anticoagulation challenges and fetal protection strategies |
| title_full_unstemmed | Mechanical tricuspid valve thrombosis in pregnancy: a case report and literature review on anticoagulation challenges and fetal protection strategies |
| title_short | Mechanical tricuspid valve thrombosis in pregnancy: a case report and literature review on anticoagulation challenges and fetal protection strategies |
| title_sort | mechanical tricuspid valve thrombosis in pregnancy a case report and literature review on anticoagulation challenges and fetal protection strategies |
| topic | mechanical valve thrombosis maternal cardiac disease anticoagulation therapy in pregnancy fetal hemodynamic adaptation multidisciplinary pregnancy care prenatal environmental factors |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1596199/full |
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