Prosthetic Valve Thrombosis in Pregnancy: A Promising Treatment for a Rare and Mostly Preventable Complication
Prosthetic heart valve thrombosis (PVT) is a rare complication, with an estimated incidence of 0.1-5.7% per patient-year1. However, during pregnancy, changes in the hemostatic system lead to a pro-coagulant state that increases the risk of PVT up to 10%2. This maternal and fetal life-threatening complication is mostly preventable with long-term adequate anticoagulation therapy. When anticoagulation fails, treatment focuses on choosing between cardiac surgery and thrombolysis, two therapeutic strategies whose risks and benefits for the mother and fetus are difficult to assess.
The study by Ozkan et al.3, in this issue of Circulation, is the largest series of pregnant patients with prosthetic mitral valve thrombosis reported to date and offers interesting results in a scenario where randomized clinical trials are not feasible. A protocol of low-dose, slow infusion of t-PA with repeated doses as needed and transesophageal echocardiography guided, was associated with a successful thrombolysis in all episodes, with no maternal deaths and a fetal mortality rate of 20%, results that seem to be better than other thrombolytic strategies reported.
- Received June 25, 2013.
- Accepted June 27, 2013.