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A Report of a Case: Anesthetic Management of a Parturient with Severe Thrombotic Stenosis of a Mechanical Aortic Valve—An Exercise in Coordination of Subspecialties

Department of Anesthesia, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467 ainyang{at}montefiore.org

Mark Jackson, MD

Ashok Kumar, MD

Andre Nychka, MD

Galina Leyvi, MD

Ilya Zhuravlev, MD

Departments of Anesthesiology Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY

Konstadinos Plestis, MD

Departments of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY

John Wasnick, MD

Departments of Anesthesiology Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY

The pregnant woman with valvular heart disease presents significant challenges to the obstetric, anesthesiology, and cardiology teams. Although successful outcomes for both mother and fetus are possible with coordinated medical care, the patient with a prosthetic valve who requires systemic anticoagulation provides a dilemma of insufficient anticoagulation leading to valve thrombosis versus the risks of maternal perinatal hemorrhage or fetal effects from oral or parenteral anticoagulants. This case report describes the peripartum management of a patient at 27 weeks' gestation with thrombus ona prosthetic aortic valve.

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