Korean Circ J.  2014 Jul;44(4):268-270. 10.4070/kcj.2014.44.4.268.

Potential Inherited Causes of Recurrent Prosthetic Mitral Valve Thrombosis in a Pregnant Patient Suffering from Recurrent Miscarriage

• Kalcik M
• Gursoy MO
• Karakoyun
• Yesin M
• Astarcioglu MA
• Ozkan M

• KMID: 2223889
• DOI: http://doi.org/10.4070/kcj.2014.44.4.268

Abstract

An effective anticoagulation is critical in pregnant patients with prosthetic heart valves. Inherited disorders may interfere with the coagulation cascade and may be associated with obstetrical complications as well as with prosthetic valve-derived complications. The patient in the present case had a history of recurrent prosthetic heart valve thrombosis (PHVT) despite an effective anticoagulation. She underwent a thrombolysis with low-dose prolonged infusion of tissue-type plasminogen activator for the management of her recurrrent prosthetic valve thrombosis. The genetic testing showed homozygous mutations of methylenetetrahydrofolate reductase (MTHFR) A 1298 C and heterozygous mutations of beta-fibrinogen 455 G-A. Inherited disorders such as MTHFR A 1298 C and fibrinogen 455G/A polymorphisms may be involved in the pathogenesis of recurrent PHVT and/or pregnancy loss.

Keyword

Pregnancy; Heart valves; Thrombophilia; Abortion, spontaneous; Thrombosis

MeSH Terms

Abortion, Habitual*
Abortion, Spontaneous
Female
Fibrinogen
Genetic Testing
Heart Valves
Humans
Methylenetetrahydrofolate Reductase (NADPH2)
Mitral Valve*
Pregnancy
Thrombophilia
Thrombosis*
Tissue Plasminogen Activator
Fibrinogen
Methylenetetrahydrofolate Reductase (NADPH2)
Tissue Plasminogen Activator

Figure

• 

  Fig. 1 Transesophageal echocardiography demonstrates the prosthetic valve thrombosis (arrows) (A). The thrombus is successfully lyzed by low dose slow infusion of tissue-plasminogen activator (B). LA: left atrium, LV: left ventricle.

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