CASE REPORT

Obstetrics and Gynecology

doi: 10.25005/2074-0581-2023-25-3-441-447
EMERGENCY CESAREAN SECTION WITH REDO MITRAL VALVE REPLACEMENT FOR ACUTE PROSTHETIC VALVE DYSFUNCTION: A CASE REPORT

I. Kholod1, E. Buhman1, S. Grisaru-Granovsky2, T. Avitan2, S. Tager3, A. Nir4, A. Tvito5, Y. Gozal1, A. Ioscovich1

1Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel
2Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel
3Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel
4Department of Cardiology, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel
5Department of Hematology, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel

Objective: Cardiovascular diseases emerge as one of the leading causes of maternal morbidity and mortality in developed countries. These risks are even higher in women with prosthetic cardiac valves. The core of the care for these women and the fetus during the hypercoagulable state of the pregnancy and postpartum period is the achievement of coagulation control using adjusted anticoagulation therapy protocols. A multidisciplinary team that includes obstetricians, cardiologists, hematologists, and anesthesiologists in a referral center is essential for an optimal maternal-fetal outcome. In particular, these measures are directed at preventing one of the most serious complications associated with mechanical valve dysfunction. The dysfunctional valve in the mitral position increases maternal and fetal mortality by 30%, especially in the presence of heart failure symptoms. Here we present a case of a 32-week pregnant woman diagnosed with dysfunction of the mechanical mitral valve (MV) and an emergency multidisciplinary approach to her treatment.

Keywords: Pregnancy, cesarean delivery, anesthetic management, mechanical valve, valve dysfunction, valve replacement.

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References
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Author information:


Kholod Ilia, MD,
Resident of Anesthesiology Program, Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with Hebrew University
Researcher ID: IWD-8768-2023
ORCID ID: 0009-0005-3397-1115
E-mail: holodis108@gmail.com

Buchmal Emmanuel, MD,
Senior Doctor, Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with Hebrew University
ORCID ID: 0009-0009-6373-3862
E-mail: buhmandoc@szmc.org.il

Grisaru-Granovsky Sorina,
Professor, Head of the Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 6602935452
ORCID ID: 0000-0003-3651-5156
E-mail: sorina@szmc.org.il

Avitan Tahila, MD,
Senior Doctor, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 56604228200
ORCID ID: 0000-0003-4402-0882
E-mail: avitan@szmc.org.il

Tager Salis, MD,
Head of the Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 6701354823
ORCID ID: 0009-0006-3520-6019
E-mail: salist@szmc.org.il

Nir Amiran,
Professor, Head of Pediatric Cardiology Unit, Department of Cardiology, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 7005974960
ORCID ID: 0000-0001-8195-0523
E-mail: nira@szmc.org.il

Tvito Ariella, MD,
Senior Doctor, Department of Hematology, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 55537589100
ORCID ID: 0000-0002-9371-6715
E-mail: ariellat@szmc.org.il

Gozal Yaacov,
Clinical Associate Professor, Head of Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 34769823800
ORCID ID: 0000-0002-9451-818X
E-mail: gozaly@szmc.org.il

Ioscovich Alexander,
Clinical Associate Professor, Head of Obstetric Anesthesiology Unit, Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with Hebrew University
Scopus ID: 57207802045
ORCID ID: 0000-0001-6449-0254
E-mail: aioscovich@gmail.com

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:


Kholod Ilia, MD
Resident of Anesthesiology Program, Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with Hebrew University

9103102, Israel, Jerusalem, Shmuel Bait str., 12, 3rd floor

Tel.: +972 (54) 2309099

E-mail: holodis108@gmail.com

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