CASE REPORT article
Front. Pediatr.
Sec. Obstetric and Pediatric Pharmacology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1596199
This article is part of the Research TopicEnhancing Drug Safety for Pregnant and Lactating Women: Addressing Perinatal Pharmacotherapy ChallengesView all 4 articles
Mechanical Tricuspid Valve Thrombosis in Pregnancy: A Case Report and Literature Review on Anticoagulation Challenges and Fetal Protection Strategies
Provisionally accepted
- 1Sichuan University, Chengdu, China
- 2West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Background: Pregnancy in women with mechanical heart valves (MHVs) poses significant challenges in balancing maternal thromboprophylaxis and fetal safety. Anticoagulation strategies must simultaneously prevent life-threatening valve thrombosis and minimize fetal risks, yet optimal management remains controversial. While warfarin offers effective thromboprophylaxis, its embryotoxicity at higher doses (>5 mg/day) contrasts with low molecular weight heparin (LMWH), which lacks consensus on thrombotic efficacy despite fetal safety advantages.Case Presentation: We report a case of a 30-year-old woman with mechanical mitral and tricuspid valves. She was maintained on low-dose warfarin (target INR 2.5–3.0) during early pregnancy. At 26–28 weeks of gestation, she developed exertional dyspnea; initial imaging showed stable valve function. At 33+2 weeks, worsening symptoms and echocardiographic evidence of tricuspid valve dysfunction prompted anticoagulation transition from warfarin to LMWH combined with vitamin K. After achieving an INR <1.4, cesarean delivery was performed at 33+3 weeks under general anesthesia, resulting in a live male infant without cardiac anomalies. Three days postpartum, mechanical tricuspid valve thrombosis with severe regurgitation was confirmed, necessitating bioprosthetic valve replacement on postoperative day 4. Maternal and neonatal outcomes were favorable.Conclusions: This case highlights the importance of individualized anticoagulation management, multidisciplinary coordination, and vigilant monitoring in optimizing outcomes for pregnant patients with MHVs. Tailored pharmacologic strategies represent key modifiable prenatal factors influencing both maternal safety and child health.
Keywords: Mechanical valve thrombosis, Maternal cardiac disease, Anticoagulation therapy in pregnancy, Fetal hemodynamic adaptation, Multidisciplinary pregnancy care, Prenatal environmental factors, Long-term child health outcomes
Received: 19 Mar 2025; Accepted: 19 May 2025.
Copyright: © 2025 Zhu, Can, Luo, Zhang and Wei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qiang Wei, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, 610000, Sichuan Province, China
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