Acute thrombosis of a composite ascending aortic conduit containing a Bjork-Shiley valve during pregnancy: successful emergency cesarean section and operative repair.

A 31-year-old female had an ascending aortic conduit with a Bjork-Shiley valve placed for an aortic dissection. A year later she became pregnant and was placed on heparin instead of coumadin therapy. She then developed a distal aortic dissection and was hospitalized for close medical monitoring of fetal status and maturity. At 33 weeks of gestation the aortic valve thrombosed, resulting in pulmonary edema and cardiac arrest. Emergency cesarean section and replacement of the aortic valve and ascending aortic conduit was successful in salvaging mother and child. Both are well at 2 years followup. The case illustrates the hazards of prosthetic valves in pregnant patients and cardiac surgery during pregnancy. These issues are reviewed along with the details leading to successful surgical management.

Duke Scholars

Author Victor J. Dzau Medicine, Cardiology