Zhu San, Luo Can, Luo Bing, Zhang Yaoyao, Wei Qiang
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
Front Pediatr. 2025 Jul 2;13:1596199. doi: 10.3389/fped.2025.1596199. eCollection 2025.
Pregnancy 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.
We 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.
This 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.
患有机械心脏瓣膜（MHV）的女性怀孕在平衡孕产妇血栓预防和胎儿安全方面带来了重大挑战。抗凝策略必须同时预防危及生命的瓣膜血栓形成并将胎儿风险降至最低，但最佳管理仍存在争议。虽然华法林可提供有效的血栓预防，但高剂量（>5毫克/天）时其胚胎毒性与低分子量肝素（LMWH）形成对比，尽管LMWH具有胎儿安全优势，但其血栓形成疗效尚无共识。
我们报告一例30岁患有机械二尖瓣和三尖瓣的女性病例。她在妊娠早期一直服用低剂量华法林（目标国际标准化比值[INR]为2.5 - 3.0）。在妊娠26 - 28周时，她出现劳力性呼吸困难；初始影像学检查显示瓣膜功能稳定。在妊娠33 + 2周时，症状恶化且超声心动图显示三尖瓣功能障碍，促使抗凝治疗从华法林转换为LMWH联合维生素K。在INR <1.4后，于33 + 3周在全身麻醉下进行剖宫产，产下一名无心脏异常的活男婴。产后三天，确诊为机械性三尖瓣血栓形成伴严重反流，需要在术后第4天进行生物人工瓣膜置换。母婴结局良好。
本病例强调了个体化抗凝管理、多学科协调以及密切监测对于优化患有MHV的孕妇结局的重要性。量身定制的药物策略是影响孕产妇安全和儿童健康的关键可改变产前因素。
