Huge Prosthetic Mitral Valve Thrombosis in a Pregnant Woman

Abstract

A 42-year-old woman in her 30th week of pregnancy who had undergone a mitral valve replacement with a 29-mm St. Jude Medical mechanical prosthetic valve (St. Jude Medical, St. Paul, Minn) 2 years earlier was referred to our hospital with severe dyspnea. She had a history of irregular and subtherapeutic use of enoxaparin 6000 IU/d until admission. Transthoracic echocardiography revealed a mean diastolic mitral transvalvular gradient of 29 mm Hg, mitral valve area of 0.6 cm2, and a giant thrombus with mobile components on the prosthetic valve (Figure 1; online-only Data Supplement Movie I). In spite of the large prosthetic mitral valve thrombosis, she had no history …