Davis Margot, Kiess Marla, Rychel Valerie, Fofonoff Doreen, Grewal Jasmine
Division of Cardiology, University of British Columbia, St. Paul's Hospital, Vancouver, Canada.
J Heart Valve Dis. 2012 Nov;21(6):783-7.
Starr-Edwards ball-in-cage prosthetic heart valves, although durable, are associated with a particularly high rate of thromboembolic complications. This valve is seldom used in North America, and is certainly not the valve of choice in a woman of childbearing age. Few reports exist from the 1970s of thrombotic complications in pregnant women with Starr-Edwards prostheses, and the optimal management strategy for such valves is unclear. Here, the case is reported of a 31-year-old woman with a Starr-Edwards prosthesis in the mitral position who was transferred to the authors' center at six weeks' gestation with pulmonary edema. Transthoracic echocardiography demonstrated thrombosis of the prosthetic valve, with a mean gradient of 23 mmHg. When treated initially with intravenous heparin and furosemide the patient improved significantly; however, the optimal management going forward was unclear. Here, the options for anticoagulation during pregnancy and for management in the event of valve thrombosis are reviewed. In the absence of any clear guidelines, a thorough discussion of the various risks and benefits with the patient is necessary, but ultimately any consideration of the risk to the mother is paramount.
斯塔尔-爱德华兹笼球式人工心脏瓣膜虽然耐用，但血栓栓塞并发症的发生率特别高。这种瓣膜在北美很少使用，对于育龄女性来说肯定不是首选瓣膜。20世纪70年代关于使用斯塔尔-爱德华兹假体的孕妇发生血栓并发症的报道很少，而且此类瓣膜的最佳管理策略尚不清楚。在此，报告一例31岁二尖瓣位植入斯塔尔-爱德华兹假体的女性患者，在妊娠六周时因肺水肿被转诊至作者所在中心。经胸超声心动图显示人工瓣膜血栓形成，平均压差为23 mmHg。最初用静脉肝素和速尿治疗后患者明显好转；然而，后续的最佳管理方案尚不清楚。在此，对妊娠期间的抗凝选择以及瓣膜血栓形成时的管理进行综述。在没有明确指南的情况下，有必要与患者全面讨论各种风险和益处，但最终任何对母亲风险的考量都是至关重要的。
