Halldorsdottir H, Nordström J, Brattström O, Sennström M M, Sartipy U, Mattsson E
Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Sweden; Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Sweden.
Int J Obstet Anesth. 2016 May;26:75-8. doi: 10.1016/j.ijoa.2015.11.008. Epub 2015 Dec 10.
Pregnancy is associated with an increased risk of thrombosis in women with mechanical prosthetic heart valves. We present the case of a 29-year-old woman who developed early postpartum mitral valve thrombus after an elective cesarean delivery. The patient had a mechanical mitral valve and was treated with warfarin in the second trimester, which was replaced with high-dose dalteparin during late pregnancy. Elective cesarean delivery was performed under general anesthesia at 37weeks of gestation. The patient was admitted to the intensive care unit for postoperative care and within 30min she developed dyspnea and hypoxia requiring mechanical ventilation. She deteriorated rapidly and developed pulmonary edema, worsening hypoxia and severe acidosis. Urgent extra corporeal membrane oxygenation was initiated. Transesophageal echocardiography revealed a mitral valve thrombus. The patient underwent a successful mitral valve replacement after three days on extra corporeal membrane oxygenation. This case highlights the importance of multidisciplinary care and frequent monitoring of anticoagulation during care of pregnant women with prosthetic heart valves.
对于患有机械人工心脏瓣膜的女性，妊娠会增加血栓形成的风险。我们报告一例29岁女性病例，该患者在择期剖宫产术后早期发生了二尖瓣血栓。该患者植入了机械二尖瓣，孕中期使用华法林治疗，妊娠晚期改用大剂量达肝素。妊娠37周时在全身麻醉下进行了择期剖宫产。患者术后入住重症监护病房，术后30分钟内出现呼吸困难和低氧血症，需要机械通气。她病情迅速恶化，出现肺水肿、低氧血症加重和严重酸中毒。紧急启动体外膜肺氧合。经食管超声心动图显示二尖瓣血栓。患者在接受体外膜肺氧合三天后成功进行了二尖瓣置换术。该病例强调了对患有人工心脏瓣膜的孕妇进行多学科护理以及在护理期间频繁监测抗凝情况的重要性。
