A Case of Mitral Valve Replacement with Neurologic Manifestations during Pregnancy

Document Type: Case Report

Authors

1 Department of Cardiac Surgery, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Anesthesiology, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Cardiopulmonary bypass in pregnant patient is considered a high-risk procedure.  Maternal mortality is similar to that of the non-pregnant females about 1.5-5%. Variations in the timing of surgical intervention, gestational age, maternal health sta‌‌‌‌tus, perfusion protocol, and pharmacologic therapy are all factors that can influence fetomaternal outcome.
Case Report: We present a case of 26- year- old pregnant woman (G1, Ab0, D0) in gestational age of 36 weeks with sudden CVA and neurological sequelae (disartheria, paresthesia of right side of face). In her past medical history, she had no positive history of neurologic problems, diabetes mellitus, hyperlipidemia or cardiovascular diseases. Left perisylvian encephalitis was reported in her brain MRI. In trans-thoracic echocardiography moderate Mitral Regurgitation (MR), severe mitral stenosis with gradient of 9mmHg, and valve surface of 1cm2 was observed. In obstetrics consultation, a healthy male fetus with approximate gestational age of 37 weeks was reported. Finally the pregnancy ended by caesarean section under general anesthesia, with presence of cardiologist and a healthy newborn was delivered at age of 37 weeks. Four days after caesarean section, Mitral Valve Replacement (MVR) was measured which proceeded successfully.
Conclusion:Due to the risk of further neurological complications in a pregnant mother who suffers from mitral valve stenosis, provided the gestational age permits harmless termination of pregnancy, it is possible to perform the mitral valve replacement procedure during the same hospital stay after termination of pregnancy.

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