Prabhadevi Kodey1, John Satish Rudrapogu2, Vijaya Kumar Netala3, Srinivasa Rao Gondi4, Lakshminarayana Kota5
PRESENTATION OF CASE
Arterial thromboembolism is very uncommon in pregnancy. It is associated with complications like sudden death and long-term morbidity. Heart valve thrombosis without anticoagulation is devastating. All patients with mechanical prosthetic valves must continue anticoagulation without fail. If patient wants to have pregnancy, the type of anticoagulation should be changed according to period of gestation and condition. Maternal and foetal condition should be closely monitored. In patients of heart disease with mechanical prosthetic mitral valve, pregnancy is avoided due to the risk of complications during pregnancy. But, some patients insist on having a child due to their social need in spite of dreaded complications. Such patients should have anticoagulants under supervision of cardiologist.
A 22-year-old primi of 6th months pregnancy who had mitral valve replacement with mechanical prosthetic valve 5 years ago stopped anticoagulants after conception, developed symptoms of sudden shortness of breath, vomiting, palpitations, weakness of both lower limbs and right upper limb with numbness and not able to walk of two days duration admitted as an emergency in Cardiology Intensive Care, NRI General Hospital. On examination- Patient conscious. Temperature 101°F, pulse rate-150/mt., respiratory rate- 28 cycles/minute, BP- 110/78 mmHg and SPO2- 85% with 5 litres oxygen. Right upper limb and both lower limbs were cold. Pulse of right brachial artery and both dorsalis pedis were feeble.
Cardiovascular System- S1 and S2- Normal. Soft prosthetic valve click audible in mitral area. Lungs- Fine crackles present bilaterally.
Per abdominal examination- Uterus 24 weeks. Foetal parts felt, foetal heart sounds good.
