Early postpartum mitral valve thrombosis requiring extra corporeal membrane oxygenation before successful valve replacement

• Pregnant women with mechanical valves need multidisciplinary care during pregnancy.
• Anticoagulation therapy is challenging in pregnant women with mechanical valves.
• We report the case of a patient who, despite anticoagulation, decompensated due to valve thrombosis.
• Extra corporeal membrane oxygenation was used until her valve was replaced.

Pregnancy is associated with an increased risk of thrombosis in women with mechanical prosthetic heart valves. We present the case of a 29-year-old woman who developed early postpartum mitral valve thrombus after an elective cesarean delivery. The patient had a mechanical mitral valve and was treated with warfarin in the second trimester, which was replaced with high-dose dalteparin during late pregnancy. Elective cesarean delivery was performed under general anesthesia at 37 weeks of gestation. The patient was admitted to the intensive care unit for postoperative care and within 30 min she developed dyspnea and hypoxia requiring mechanical ventilation. She deteriorated rapidly and developed pulmonary edema, worsening hypoxia and severe acidosis. Urgent extra corporeal membrane oxygenation was initiated. Transesophageal echocardiography revealed a mitral valve thrombus. The patient underwent a successful mitral valve replacement after three days on extra corporeal membrane oxygenation. This case highlights the importance of multidisciplinary care and frequent monitoring of anticoagulation during care of pregnant women with prosthetic heart valves.